EAARN评分对于心脏再同步治疗患者临床预后的预测价值  

Prediction efficiency of EAARN score for clinical outcome in patients with cardiac resynchronization therapy

作　　者：杨绳文 刘志敏[1] 糜家睿[1] 刘尚雨 丁立刚[1] 陈柯萍[1] 华伟[1] 张澍[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心心血管疾病国家重点实验室阜外医院心律失常中心,100037

出　　处：《中华心律失常学杂志》2016年第5期404-408,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：国家科技支撑计划（2011BAI11B00）

摘　　要：目的 探讨EAARN评分系统对心脏再同步治疗（cardiac resynchronization therapy,CRT）患者全因死亡的预测价值.方法 回顾性选取2010年1月至2014年12月于阜外医院心律失常中心首次接受CRT的264例患者临床资料,行EAARN评分（E：左心室射血分数,A：年龄,A：房颤,R：肾功能,N：纽约心脏病学会心功能分级）,随访终点为全因死亡.Kaplan-Meier法比较各组临床预后,采用受试者工作特征（receiver operating characteristic）曲线下面积（area under curve,AUC）评估EAARN评分系统对接受CRT患者全因死亡的预测价值,采用Hosmer-Lemeshow法评价拟合度.结果 共有33例患者在随访时间内死亡,定义0～1个低危组;2～3个中危组;3个以上高危组.其中低危组共199例,死亡22例;中危组共42例,死亡5例;高危组共23例,死亡6例.3组间患者死亡率差异无统计学意义（log-rank检验,P=0.316）.EARRN评分系统预测1年内全因死亡的AUC为0.559.Hosmer-Lemeshow拟合度尚可（P=0.49）.结论 EAARN评分系统对CRT患者预后的预测效能不佳.Objective To evaluate the role of EAARN score in risk-stratifying in patients with heart failure （HF） who underwent cardiac resynchronization therapy （CRT） and in predicting prognosis.Methods In this single-center retrospective cohort study,a total of 264 HF patients which had CRT implantation between January 2010 and December 2014 were enrolled.Primary outcomes were defined as all-cause mortality.Patients were divided into three groups according to EAARN score system：0-1 scores group （n =199）,2-3 scores group （n =42） and ＞3 scores group （n =23）.Kaplan-Meier analyses for each group and score were analyzed respectively.Discrimination and calibration of EAARN score system were evaluated through c-statistics and Hosmer-Lemeshow（H-L） goodness-of-fit test.Results A total of 33 patients died,22 of 199 patients died in 0-1 score group,5 of 42 died in 2-3 scores group,and 6 of 23 died in ＞3 scores group.There were no significantly difference among 3 groups （log-rank test,P=0.316）.Discrimination of EAARN was inadequate for the outcome （AUC =0.559）.EAARN was a good fit of dead for all-cause mortality （P =0.49）.Conclusion The EAARN score system unsuccessfully stratifies HF patients with CRT.

关 键 词：心脏再同步治疗 评分系统 心力衰竭 危险因素 预测效能 

分 类 号：R541.6[医药卫生—心血管疾病]