Usefulness of the CRT-SCORE for Shared Decision-Making in Cardiac Resynchronization Therapy in Patients with Left Ventricular Ejection Fraction ≤ 35%.

4 years ago

Usefulness of the CRT-SCORE for Shared Decision-Making in Cardiac Resynchronization Therapy in Patients with Left Ventricular Ejection Fraction ≤ 35%.

Individualized estimation of prognosis after cardiac resynchronization therapy (CRT) remains challenging. Our aim was to develop a multi-parametric prognostic risk score (CRT-SCORE) that could be used for patient-specific clinical shared decision-making about CRT implantation. The CRT-SCORE was derived from an ongoing CRT registry, including 1053 consecutive patients (age 67±10 years, 76% male). Using pre-implantation variables, 100 multiple-imputed datasets were generated for model calibration. Based on multivariate Cox-regression models, cross-validated linear prognostic-scores were calculated, as well as survival fractions at 1 and 5 years. Specifically, the CRT-SCORE was calculated using atrioventricular junction ablation, age, gender, etiology, New York Heart Association class, diabetes, hemoglobin level, renal function, left bundle branch block, QRS duration, atrial fibrillation, left ventricular systolic and diastolic function and mitral regurgitation, and showed a good discriminative ability (AUC 0.773 at 1 year and 0.748 at 5 years). During long-term follow-up (median 60-months, IQR 31-85), all-cause mortality was observed in 494 (47%) patients. Based on distribution of CRT-SCORE, lower and higher risk patient groups were identified. An estimated mean survival of 98% at 1 year and 92% at 5 years were observed in the lowest 5% risk group (L5 CRT-SCORE:-4.42 to -1.60), while the highest 5% risk group (H5 CRT-SCORE: 1.44 to 2.89) showed poor survival: 78% at 1 year and 22% at 5 years. In conclusion, the CRT-SCORE allows accurate prediction of 1 and 5 year survival after CRT using readily available and CRT-specific clinical, electrocardiographic and echocardiographic parameters. The model may assist clinicians in counseling patients and in decision-making.

Publisher URL: www.sciencedirect.com/science

DOI: S0002914917313899