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.

Validation of a simple risk stratification tool for patients implanted with Cardiac Resynchronization Therapy: The VALID-CRT risk score / Gasparini, Maurizio; Klersy, Catherine; Leclercq, Cristophe; Lunati, Maurizio; Landolina, Maurizio; Auricchio, Angelo; Santini, Massimo; Boriani, Giuseppe; Proclemer, Alessandro; Leyva, Francisco. - In: EUROPEAN JOURNAL OF HEART FAILURE. - ISSN 1388-9842. - 17:7(2015), pp. 717-724. [10.1002/ejhf.269]

Validation of a simple risk stratification tool for patients implanted with Cardiac Resynchronization Therapy: The VALID-CRT risk score

BORIANI, Giuseppe;
2015

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.
2015
23-apr-2015
17
7
717
724
Validation of a simple risk stratification tool for patients implanted with Cardiac Resynchronization Therapy: The VALID-CRT risk score / Gasparini, Maurizio; Klersy, Catherine; Leclercq, Cristophe; Lunati, Maurizio; Landolina, Maurizio; Auricchio, Angelo; Santini, Massimo; Boriani, Giuseppe; Proclemer, Alessandro; Leyva, Francisco. - In: EUROPEAN JOURNAL OF HEART FAILURE. - ISSN 1388-9842. - 17:7(2015), pp. 717-724. [10.1002/ejhf.269]
Gasparini, Maurizio; Klersy, Catherine; Leclercq, Cristophe; Lunati, Maurizio; Landolina, Maurizio; Auricchio, Angelo; Santini, Massimo; Boriani, Gius...espandi
File in questo prodotto:
File Dimensione Formato  
ejhf.269.pdf

Accesso riservato

Tipologia: Versione pubblicata dall'editore
Dimensione 363.63 kB
Formato Adobe PDF
363.63 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1139629
Citazioni
  • ???jsp.display-item.citation.pmc??? 15
  • Scopus 39
  • ???jsp.display-item.citation.isi??? 39
social impact