Prediction of Recurrent Heart Failure Hospitalizations and Mortality Using the Echocardiographic Killip Score

Overview

Journal Clin Res Cardiol

Specialty Cardiology & Vascular Diseases

Date 2024 Jun 3

PMID 38829411

Authors

Yoav Granot

Yuval Meir

Michal Laufer Perl

Assi Milwidsky

Ben Sadeh

Orly Ran Sapir

Adva Trabelsi

Shmuel Banai

Yan Toplisky

Ofer Havakuk

Affiliations

Soon will be listed here.

Abstract

Aim: Examine the performance of a simple echocardiographic "Killip score" (eKillip) in predicting heart failure (HF) hospitalizations and mortality after index event of decompensated HF hospitalization.

Methods: HF patients hospitalized at our facility between 03/2019-03/2021 who underwent an echocardiography during their index admission were included in this retrospective analysis. The cohort was divided into 4 classes of eKillip according to: stroke volume index (SVI) < 35ml/m > and E/E' ratio < 15 > . An eKillip Class I was defined as SVI ≥ 35ml/m and E/E' ≤ 15 and was used as reference.

Results: Included 751 patients, median age 78.1 (IQR 69.3-86) years, 59% men, left ventricular ejection fraction 45 (IQR 30-60)%, brain natriuretic peptide levels 634 (IQR 331-1222)pg/ml. Compared with eKillip Class I, a graded increase in the combined endpoint of 30-day mortality and rehospitalizations rates was noted: (Class II: HR 1.77, CI 0.95-3.33, p = 0.07; Class III: HR 1.94, CI 1.05-3.6, p = 0.034; Class IV: HR 2.9, CI 1.64-5.13, p < 0.001 respectively), which overall persisted after correction for clinical (Class II: HR 1.682, CI 0.9-3.15, p = 0.105; Class III: HR 2.104, CI 1.13-3.9, p = 0.019; Class IV: HR 2.74, CI 1.54-4.85, p = 0.001 respectively) or echocardiographic parameters (Class II: HR 1.92, CI 1.02-3.63, p = 0.045; Class III: HR 1.54, CI 0.81-2.95, p = 0.189; Class IV: HR 2.04, CI 1.1-3.76, p = 0.023 respectively). Specifically, the eKillip Class IV group comprised one-third of the patient population and persistently showed increased risk of 30-day HF hospitalizations or mortality following multivariate analysis.

Conclusion: A simple echocardiographic score can assist identifying high-risk decompensated HF patients for recurrent hospitalizations and mortality.

References

Osenenko K, Kuti E, Deighton A, Pimple P, Szabo S . Burden of hospitalization for heart failure in the United States: a systematic literature review. J Manag Care Spec Pharm. 2022; 28(2):157-167. PMC: 10373049. DOI: 10.18553/jmcp.2022.28.2.157. View

KILLIP 3rd T, KIMBALL J . Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol. 1967; 20(4):457-64. DOI: 10.1016/0002-9149(67)90023-9. View

El-Menyar A, Zubaid M, Almahmeed W, Sulaiman K, Alnabti A, Singh R . Killip classification in patients with acute coronary syndrome: insight from a multicenter registry. Am J Emerg Med. 2010; 30(1):97-103. DOI: 10.1016/j.ajem.2010.10.011. View

Khot U, Jia G, Moliterno D, Lincoff A, Khot M, Harrington R . Prognostic importance of physical examination for heart failure in non-ST-elevation acute coronary syndromes: the enduring value of Killip classification. JAMA. 2003; 290(16):2174-81. DOI: 10.1001/jama.290.16.2174. View

Launbjerg J, Berning J, Fruergaard P, Eliasen P, Borch-Johnsen K, Eiken P . Risk stratification after acute myocardial infarction by means of echocardiographic wall motion scoring and Killip classification. Cardiology. 1992; 80(5-6):375-81. DOI: 10.1159/000175028. View

Degeare V, Boura J, Grines L, ONeill W, Grines C . Predictive value of the Killip classification in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol. 2001; 87(9):1035-8. DOI: 10.1016/s0002-9149(01)01457-6. View

Milwidsky A, Greidinger D, Frydman S, Hochstadt A, Ifrach-Kashtan N, Mizrachi M . Echocardiographic Killip Classification. J Am Soc Echocardiogr. 2021; 35(3):287-294. DOI: 10.1016/j.echo.2021.10.012. View

Dini F, Carluccio E, Bitto R, Ciccarelli M, Correale M, DAgostino A . Echocardiographically defined haemodynamic categorization predicts prognosis in ambulatory heart failure patients treated with sacubitril/valsartan. ESC Heart Fail. 2022; 9(2):1107-1117. PMC: 8934975. DOI: 10.1002/ehf2.13779. View

Carluccio E, Dini F, Bitto R, Ciccarelli M, Correale M, DAgostino A . Benefit from sacubitril/valsartan is associated with hemodynamic improvement in heart failure with reduced ejection fraction: An echocardiographic study. Int J Cardiol. 2022; 350:62-68. DOI: 10.1016/j.ijcard.2022.01.004. View

10.

McDonagh T, Metra M, Adamo M, Gardner R, Baumbach A, Bohm M . 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42(36):3599-3726. DOI: 10.1093/eurheartj/ehab368. View

11.

Mitchell C, Rahko P, Blauwet L, Canaday B, Finstuen J, Foster M . Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2018; 32(1):1-64. DOI: 10.1016/j.echo.2018.06.004. View

12.

Ommen S, Nishimura R, Appleton C, Miller F, Oh J, Redfield M . Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation. 2000; 102(15):1788-94. DOI: 10.1161/01.cir.102.15.1788. View

13.

Okura H, Kubo T, Asawa K, Toda I, Yoshiyama M, Yoshikawa J . Elevated E/E' predicts prognosis in congestive heart failure patients with preserved systolic function. Circ J. 2008; 73(1):86-91. DOI: 10.1253/circj.cj-08-0457. View

14.

Okura H, Takada Y, Kubo T, Iwata K, Mizoguchi S, Taguchi H . Tissue Doppler-derived index of left ventricular filling pressure, E/E', predicts survival of patients with non-valvular atrial fibrillation. Heart. 2006; 92(9):1248-52. PMC: 1861171. DOI: 10.1136/hrt.2005.082594. View

15.

Patel H, Miyoshi T, Addetia K, Henry M, Citro R, Daimon M . Normal Values of Cardiac Output and Stroke Volume According to Measurement Technique, Age, Sex, and Ethnicity: Results of the World Alliance of Societies of Echocardiography Study. J Am Soc Echocardiogr. 2021; 34(10):1077-1085.e1. PMC: 9149664. DOI: 10.1016/j.echo.2021.05.012. View

16.

Simpson J, Jhund P, Lund L, Padmanabhan S, Claggett B, Shen L . Prognostic Models Derived in PARADIGM-HF and Validated in ATMOSPHERE and the Swedish Heart Failure Registry to Predict Mortality and Morbidity in Chronic Heart Failure. JAMA Cardiol. 2020; 5(4):432-441. PMC: 6990745. DOI: 10.1001/jamacardio.2019.5850. View

17.

Bradley J, Schelbert E, Bonnett L, Lewis G, Lagan J, Orsborne C . Predicting hospitalisation for heart failure and death in patients with, or at risk of, heart failure before first hospitalisation: a retrospective model development and external validation study. Lancet Digit Health. 2022; 4(6):e445-e454. PMC: 9130210. DOI: 10.1016/S2589-7500(22)00045-0. View

18.

Rich J, Burns J, Freed B, Maurer M, Burkhoff D, Shah S . Meta-Analysis Global Group in Chronic (MAGGIC) Heart Failure Risk Score: Validation of a Simple Tool for the Prediction of Morbidity and Mortality in Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc. 2018; 7(20):e009594. PMC: 6474968. DOI: 10.1161/JAHA.118.009594. View

19.

Abraham W, Stevenson L, Bourge R, Lindenfeld J, Bauman J, Adamson P . Sustained efficacy of pulmonary artery pressure to guide adjustment of chronic heart failure therapy: complete follow-up results from the CHAMPION randomised trial. Lancet. 2015; 387(10017):453-61. DOI: 10.1016/S0140-6736(15)00723-0. View

20.

Taylor C, Lay-Flurrie S, Ordonez-Mena J, Goyder C, Jones N, Roalfe A . Natriuretic peptide level at heart failure diagnosis and risk of hospitalisation and death in England 2004-2018. Heart. 2021; 108(7):543-549. PMC: 8921592. DOI: 10.1136/heartjnl-2021-319196. View