Maurizio Gasparini1, Catherine Klersy2, Cristophe Leclercq3, Maurizio Lunati4, Maurizio Landolina5, Angelo Auricchio6, Massimo Santini7, Giuseppe Boriani8, Alessandro Proclemer9, Francisco Leyva10. 1. Electrophysiology and Pacing Unit, Humanitas Research Hospital IRCCS, Via Manzoni 56 Rozzano (Milano), 20089, Italy. 2. Biometry and Clinical Epidemiology, Research Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy. 3. Department of Cardiology, University Hospital Rennes, Rennes, France. 4. Cardiology Department, Niguarda Ca' Granda Hospital, Milano, Italy. 5. Cardiology Department, Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy. 6. Fondazione Cardiocentro Ticino, Lugano, Switzerland. 7. Department of Cardiology, San Filippo Neri Hospital, Rome, Italy. 8. Institute of Cardiology, University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy. 9. Department of Cardiology, S. Maria della Misericordia Hospital, Udine, Italy. 10. Aston University Medical School and Queen Elizabeth Hospital, Birmingham, UK.
Abstract
AIMS: Mortality after cardiac resynchronization therapy (CRT) is difficult to predict. We sought to design and validate a simple prognostic score for patients implanted with CRT, based on readily available clinical variables, including age, gender, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class, presence/absence of atrial fibrillation, presence/absence of atrioventricular junction ablation, coronary heart disease, diabetes, and implantation of a CRT device with defibrillation. METHODS: For predictive modelling, 5153 consecutive patients enrolled in 72 European centres (79% male; LVEF 25.9 ± 6.85%; NYHA class III-IV 77.5%; QRS 158.4 ± 32.3 ms) were randomly split into derivation (70%) and validation (30%) samples. The primary endpoint was total mortality and the secondary endpoint was cardiovascular mortality. The final predictive model fit was assessed by plotting observed vs. predicted survival. RESULTS: In the entire cohort, 1004 deaths occurred over a follow-up of 14 409 person years. Total mortality ranged from 3.1% to 28.2% at 2 years in the first and fifth quintile of the risk score, respectively. At 5 years, total mortality was 10.3%, 18.6%, 27.6%, 36.1%, and 58.8%, from the first to the fifth quintile. Compared with the lowest quintile (Q), total mortality was significantly higher in the other four quintiles [Q2 hazard ratio (HR) = 1.71; Q3 HR = 2.20; Q4 HR = 4.03; Q5 HR = 8.03; all P < 0.001). The final model, which was based on the entire cohort using the above variables, showed a good discrimination (Harrell's c = 0.70) and high explained variation (0.26). The mean predicted survival fitted well with the observed survival for up to 6 years of follow-up. CONCLUSIONS: The VALID-CRT risk score, which is based on routine, readily available clinical variables, reliably predicted the long-term total and cardiovascular mortality in patients undergoing CRT. While this score cannot be used to predict the benefit of CRT, it may be useful for predicting survival after CRT. This may have useful implications for follow-up.
AIMS: Mortality after cardiac resynchronization therapy (CRT) is difficult to predict. We sought to design and validate a simple prognostic score for patients implanted with CRT, based on readily available clinical variables, including age, gender, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class, presence/absence of atrial fibrillation, presence/absence of atrioventricular junction ablation, coronary heart disease, diabetes, and implantation of a CRT device with defibrillation. METHODS: For predictive modelling, 5153 consecutive patients enrolled in 72 European centres (79% male; LVEF 25.9 ± 6.85%; NYHA class III-IV 77.5%; QRS 158.4 ± 32.3 ms) were randomly split into derivation (70%) and validation (30%) samples. The primary endpoint was total mortality and the secondary endpoint was cardiovascular mortality. The final predictive model fit was assessed by plotting observed vs. predicted survival. RESULTS: In the entire cohort, 1004 deaths occurred over a follow-up of 14 409 person years. Total mortality ranged from 3.1% to 28.2% at 2 years in the first and fifth quintile of the risk score, respectively. At 5 years, total mortality was 10.3%, 18.6%, 27.6%, 36.1%, and 58.8%, from the first to the fifth quintile. Compared with the lowest quintile (Q), total mortality was significantly higher in the other four quintiles [Q2 hazard ratio (HR) = 1.71; Q3 HR = 2.20; Q4 HR = 4.03; Q5 HR = 8.03; all P < 0.001). The final model, which was based on the entire cohort using the above variables, showed a good discrimination (Harrell's c = 0.70) and high explained variation (0.26). The mean predicted survival fitted well with the observed survival for up to 6 years of follow-up. CONCLUSIONS: The VALID-CRT risk score, which is based on routine, readily available clinical variables, reliably predicted the long-term total and cardiovascular mortality in patients undergoing CRT. While this score cannot be used to predict the benefit of CRT, it may be useful for predicting survival after CRT. This may have useful implications for follow-up.
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Authors: Emanuele Bertaglia; Giuseppe Arena; Domenico Pecora; Albino Reggiani; Antonio D'Onofrio; Pietro Palmisano; Antonio De Simone; Salvatore I Caico; Massimiliano Marini; Giampiero Maglia; Anna Ferraro; Francesco Solimene; Antonella Cecchetto; Maurizio Malacrida; Giovanni L Botto; Maurizio Lunati; Giuseppe Stabile Journal: Clin Cardiol Date: 2019-07-13 Impact factor: 2.882