PMID- 38011913 OWN - NLM STAT- MEDLINE DCOM- 20240202 LR - 20240202 IS - 2055-5822 (Electronic) IS - 2055-5822 (Linking) VI - 11 IP - 1 DP - 2024 Feb TI - Heart failure 'the cancer of the heart': the prognostic role of the HLM score. PG - 390-399 LID - 10.1002/ehf2.14594 [doi] AB - AIMS: The multi-systemic effects of heart failure (HF) resemble the spread observed during cancer. We propose a new score, named HLM, analogous to the TNM classification used in oncology, to assess the prognosis of HF. HLM refers to H: heart damage, L: lung involvement, and M: systemic multiorgan involvement. The aim was to compare the HLM score to the conventional New York Heart Association (NYHA) classification, American College of Cardiology/American Heart Association (ACC/AHA) stages, and left ventricular ejection fraction (LVEF), to assess the most accurate prognostic tool for HF patients. METHODS AND RESULTS: We performed a multicentre, observational, prospective study of consecutive patients admitted for HF. Heart, lung, and other organ function parameters were collected. Each patient was classified according to the HLM score, NYHA classification, ACC/AHA stages, and LVEF assessed by transthoracic echocardiography. The follow-up period was 12 months. The primary endpoint was a composite of all-cause death and rehospitalization due to HF. A total of 1720 patients who completed the 12 month follow-up period have been enrolled in the study. 520 (30.2%) patients experienced the composite endpoint of all-cause death and rehospitalization due to HF. 540 (31.4%) patients were female. The mean age of the study population was 70.5 +/- 12.9. The mean LVEF at admission was 42.5 +/- 13%. Regarding the population distribution across the spectrum of HLM score stages, 373 (21.7%) patients were included in the HLM-1, 507 (29.5%) in the HLM-2, 587 (34.1%) in the HLM-3, and 253 (14.7%) in the HLM-4. HLM was the most accurate score to predict the primary endpoint at 12 months. The area under the receiver operating characteristic curve (AUC) was greater for the HLM score compared with the NYHA classification, ACC/AHA stages, or LVEF, regarding the composite endpoint (HLM = 0.645; NYHA = 0.580; ACC/AHA = 0.589; LVEF = 0.572). The AUC of the HLM score was significantly better compared with the LVEF (P = 0.002), ACC/AHA (P = 0.029), and NYHA (P = 0.009) AUC. CONCLUSIONS: The HLM score has a greater prognostic power compared with the NYHA classification, ACC/AHA stages, and LVEF assessed by transthoracic echocardiography in terms of the composite endpoint of all-cause death and rehospitalization due to HF at 12 months of follow-up. CI - (c) 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. FAU - Severino, Paolo AU - Severino P AD - Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, Rome, Italy. FAU - Mancone, Massimo AU - Mancone M AD - Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, Rome, Italy. FAU - D'Amato, Andrea AU - D'Amato A AD - Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, Rome, Italy. FAU - Mariani, Marco Valerio AU - Mariani MV AD - Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, Rome, Italy. FAU - Prosperi, Silvia AU - Prosperi S AD - Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, Rome, Italy. FAU - Alunni Fegatelli, Danilo AU - Alunni Fegatelli D AD - Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy. FAU - Birtolo, Lucia Ilaria AU - Birtolo LI AD - Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, Rome, Italy. FAU - Angotti, Danilo AU - Angotti D AD - Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, Rome, Italy. FAU - Milanese, Alberto AU - Milanese A AD - Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy. FAU - Cerrato, Enrico AU - Cerrato E AD - Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli (Turin), Italy. FAU - Maestrini, Viviana AU - Maestrini V AD - Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, Rome, Italy. FAU - Pizzi, Carmine AU - Pizzi C AD - Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, IRCCS Sant'Orsola-Malpighi Hospital, Bologna, Italy. FAU - Foa, Alberto AU - Foa A AD - Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, IRCCS Sant'Orsola-Malpighi Hospital, Bologna, Italy. FAU - Vestri, Annarita AU - Vestri A AD - Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy. FAU - Palazzuoli, Alberto AU - Palazzuoli A AD - Cardiovascular Diseases Unit, Le Scotte Hospital, University of Siena, Siena, Italy. FAU - Vizza, Carmine Dario AU - Vizza CD AD - Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, Rome, Italy. FAU - Casale, Paul N AU - Casale PN AD - Department of Cardiology and Population Health Sciences, Weill Cornell Medical College, New York, NY, USA. FAU - Mather, Paul J AU - Mather PJ AD - Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA. FAU - Fedele, Francesco AU - Fedele F AD - IRCCS San Raffaele Cassino, Cassino, Italy. LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study DEP - 20231127 PL - England TA - ESC Heart Fail JT - ESC heart failure JID - 101669191 SB - IM MH - Female MH - Humans MH - Male MH - *Heart Failure/diagnosis/epidemiology MH - *Neoplasms MH - Prognosis MH - Prospective Studies MH - Stroke Volume MH - United States MH - Ventricular Function, Left MH - Middle Aged MH - Aged MH - Aged, 80 and over PMC - PMC10804198 OTO - NOTNLM OT - All-cause mortality OT - HLM score OT - Heart failure OT - Prognosis OT - Rehospitalization COIS- All the authors have no conflict of interest. EDAT- 2023/11/28 00:42 MHDA- 2024/01/24 06:43 PMCR- 2023/11/27 CRDT- 2023/11/27 20:23 PHST- 2023/11/02 00:00 [revised] PHST- 2023/08/01 00:00 [received] PHST- 2023/11/06 00:00 [accepted] PHST- 2024/01/24 06:43 [medline] PHST- 2023/11/28 00:42 [pubmed] PHST- 2023/11/27 20:23 [entrez] PHST- 2023/11/27 00:00 [pmc-release] AID - EHF214594 [pii] AID - 10.1002/ehf2.14594 [doi] PST - ppublish SO - ESC Heart Fail. 2024 Feb;11(1):390-399. doi: 10.1002/ehf2.14594. Epub 2023 Nov 27.