부산대학교 도서관

Introduction: The multiorgan involvement of heart failure is similar to the spread observed in cancer. We proposed a new score system, named HLM, analogous to TNM classification used in oncology. HLM refers to (i) H: heart damage, instead of “T” for tumor; (ii) L: lung involvement, instead of “N” for lymph nodes; (iii) M: involvement of peripheral organs, instead of “M” for metastasis.Hypothesis: to compare HLM score to NYHA class, ACC/AHA stages and HF classification by left ventricular ejection fraction (LVEF), to assess the most accurate prognostic tool for HF patients.Methods: We performed a multicentric, observational, prospective study of consecutive patients admitted for HF, or at risk for HF. All parameters for heart, lungs and organs’ function were collected. HLM score, made up of 4 stages of severity, was built starting from HLM classification. Each patient was classified according to HLM, NYHA, ACC/AHA stages and LVEF. The primary composite endpoint was all-cause death and rehospitalization due to HF; patients were followed up for 12 months.Results: We enrolled 1720 patients who completed the 12-months follow-up. As showed by Kaplan Meier curves, HLM was the most accurate score to predict primary endpoint at 12 months. The area under the ROC curve (AUC) was greater for HLM score than NYHA, ACC/AHA stages and LVEF classification, regarding the composite endpoint (HLM=0.645; NYHA=0.580; ACC/AHA=0.572; LVEF=0.572). HLM score related AUC showed statistically significant differences compared to LVEF (p=0.002), ACC/AHA (p=0.002) and NYHA (p=0.009).Conclusions: HLM score has a greater prognostic power compared to other nosologies, in terms of the composite endpoint of all-cause death and rehospitalization, at 12 months follow up.