p.24 抽出テキスト
May 3, 2022 Circulation. 2022;145:e895–e1032. DOI: 10.1161/CIR.0000000000001063 e918 CLINICAL STATEMENTS AND GUIDELINES across multiple studies.9–13,15,16,27 A cutoff of <300 m roughly correlates to patients with NYHA class III to IV symptoms and is associated with worse 3-year survival free of heart transplant (62% versus 82% for those walking ≥300 m).27 4. Dyspnea is a complex symptom that can reflect abnormalities in a number of different systems and can be influenced by psychological and environmental factors. CPET involves having patients perform a treadmill (or stationary bicycle) exercise test, while also performing ventilatory gas exchange measurements.28 CPET enables the comprehensive assessment of multiple physiological measures that can impact exercise capacity and contribute to dyspnea. It provides analysis of gas exchange and yields measures of oxygen uptake (VO2), carbon dioxide output, and ventilation. These measures can be integrated with standard exercise testing variables, such as heart rate, blood pressure, electrocardiographic findings, and symptoms to provide insights into the physiologic mechanisms underlying a patient’s dyspnea. In particular, CPET can help to distinguish respiratory versus cardiac etiologies of dyspnea. If exercise capacity is diminished but cardiopulmonary responses are normal, other causes of dyspnea, such as metabolic abnormalities and deconditioning, should be considered. 4.8 Initial and Serial Evaluation: Clinical Assessment: HF Risk Scoring Recommendation for Initial and Serial Evaluation: Clinical Assessment: HF Risk Scoring Referenced studies that support the recommendation are summarized in the Online Data Supplements. COR LOE Recommendation 2a B-NR 1. In ambulatory or hospitalized patients with HF, validated multivariable risk scores can be useful to estimate subsequent risk of mortality.1–14 Synopsis Clinicians should routinely assess a patient’s risk for an adverse outcome to guide discussions on prognosis, goals of care, and treatment decisions. Several predictive models of outcomes of patients with HF have been developed and validated using data from clinical trials, registries, and population-based cohorts. The best performing models have focused on predicting short- and long-term mortality, whereas predictive models for hospitalization or readmission for HF have generally had poor or modest discrimination. Predictive models may also assess the risk of incident HF among the general population and should be considered in the prevention of HF. In the course of standard evaluation, clinicians should routinely assess the patient’s potential for adverse outcome, because accurate risk stratification may help guide therapeutic decisionmaking, including a more rapid transition to advanced HF therapies. Several methods objectively assess risk (Table 8), including biomarker testing, as well as various multivariable clinical risk scores, and some that include Table 8. Selected Multivariable Risk Scores to Predict Outcome in HF Risk Score Reference/Link Year Published Chronic HF All Patients With Chronic HF Seattle Heart Failure Model 2 https://depts.washington.edu/shfm/?width =1440&height=900 15 2006 Heart Failure Survival Score 1 1997 MAGGIC 3 http://www.heartfailurerisk.org/ 16 2013 CHARM Risk Score 4 2006 CORONA Risk Score 5 2009 Specific to Chronic HFrEF PARADIGM-HF 6 2020 HF-ACTION 7 2012 GUIDE-IT 8 2019 Specific to Chronic HFpEF I-PRESERVE Score 9 2011 TOPCAT 10 2020 Acutely Decompensated HF ADHERE Classification and Regression Tree (CART) Model 11 2005 AHA Get With The Guidelines Score 12 https://www.mdcalc. com/gwtg-heart-failurerisk-score 17 2010, 2021 EFFECT Risk Score 13 http://www.ccort.ca/ Research/CHFRisk- Model.aspx 18 2003, 2016 ESCAPE Risk Model and Discharge Score 14 2010 ADHERE indicates Acute Decompensated Heart Failure National Registry; AHA, American Heart Association; ARIC, Atherosclerosis Risk in Communities; CHARM, Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity; CORONA, Controlled Rosuvastatin Multinational Trial in Heart Failure; EFFECT, Enhanced Feedback for Effective Cardiac Treatment; ESCAPE, Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness; GUIDE-ID, Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HF-ACTION, Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training MAGGIC Meta-analysis Global Group in Chronic Heart Failure; I-PRESERVE, Irbesartan in Heart Failure with Preserved Ejection Fraction Study; PCP-HF, Pooled Cohort Equations to Prevent HF; and TOPCAT, Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial. Downloaded from http://ahajournals.org by on October 7, 2026