Development and Validation of Predictive Models of Cardiac Mortality and Transplantation in Resynchronization Therapy

Abstract

Background30-40% of cardiac resynchronization therapy cases do not achieve favorable outcomes.ObjectiveThis study aimed to develop predictive models for the combined endpoint of cardiac death and transplantation (Tx) at different stages of cardiac resynchronization therapy (CRT).MethodsProspective observational study of 116 patients aged 64.8 ± 11.1 years, 68.1% of whom had functional class (FC) III and 31.9% had ambulatory class IV. Clinical, electrocardiographic and echocardiographic variables were assessed by using Cox regression and Kaplan-Meier curves.ResultsThe cardiac mortality/Tx rate was 16.3% during the follow-up period of 34.0 ± 17.9 months. Prior to implantation, right ventricular dysfunction (RVD), ejection fraction < 25% and use of high doses of diuretics (HDD) increased the risk of cardiac death and Tx by 3.9-, 4.8-, and 5.9-fold, respectively. In the first year after CRT, RVD, HDD and hospitalization due to congestive heart failure increased the risk of death at hazard ratios of 3.5, 5.3, and 12.5, respectively. In the second year after CRT, RVD and FC III/IV were significant risk factors of mortality in the multivariate Cox model. The accuracy rates of the models were 84.6% at preimplantation, 93% in the first year after CRT, and 90.5% in the second year after CRT. The models were validated by bootstrapping.ConclusionWe developed predictive models of cardiac death and Tx at different stages of CRT based on the analysis of simple and easily obtainable clinical and echocardiographic variables. The models showed good accuracy and adjustment, were validated internally, and are useful in the selection, monitoring and counseling of patients indicated for CRT.

Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy

“…The present study had 11.2% of chagasic patients. In another study by our team, Chagas disease was related to an increase in the risk of death only on univariate analysis, probably exceeded by right ventricular dysfunction, a variable not assessed in this study 27 .…”

“…Linde et al 25 , in a REVERSE study subanalysis , have shown that a baseline EF < 30%, as compared to values of 30%-40%, related favorably to post-CRT survival, via an index comprising clinical and echocardiographic variables, while Kronborg et al 26 have shown that a baseline EF < 22.5% increased post-CRT mortality. In a previous study, we observed that a baseline EF < 25% correlated with worse cardiac outcome, which was not maintained after 1 year when assessed with other clinical variables 27 .…”

Predictors of Total Mortality and Echocardiographic Response for Cardiac Resynchronization Therapy: A Cohort Study

“…In a recently published study conducted in a center in Brazil, with patients included between 2008 and 2013, total mortality was 25% (29/116) during follow-up of 34 ± 17 months. 12 …”

Who Are the Super-Responders to Cardiac Resynchronization Therapy?

“…We also observed a higher BMI in the SR group, which could reflect better nutritional status and, consequently, less advanced heart disease, but the The use of high doses of loop diuretics has been shown to be a marker of severity in cardiomyopathy, including in the group of patients submitted to CRT, when analyzed before implantation, as well as 1 year after the CRT. 22 The presence of a higher incidence in the NSR group may reflect this aspect.…”