Prognostic value of the MELD‐XI score in patients undergoing cardiac resynchronization therapy

Abstract

Aims Multi-organ dysfunction was recently reported to be a common condition in patients with heart failure (HF). The Model for End-stage Liver Disease eXcluding International normalized ratio (MELD-XI) score reflects liver and kidney function. The prognostic relevance of this score has been reported in patients with a variety of cardiovascular diseases who are undergoing interventional therapies. However, the relationship between the severity of hepatorenal dysfunction assessed by the MELD-XI score and the long-term clinical outcomes of HF patients receiving cardiac resynchronization therapy (CRT) has not been evaluated. Methods and results Clinical records of 283 patients who underwent CRT implantation between March 2003 and October 2020 were retrospectively evaluated (mean age 67 ± 12, 22.6% female). Blood samples were collected before CRT implantation. Patients were divided into three groups based on tertiles of the MELD-XI score: first tertile (MELD-XI = 9.44, n = 95), second tertile (9.44 < MELD-XI < 13.4, n = 94), and third tertile (MELD-XI ≥ 13.4, n = 94). The primary endpoint was all-cause mortality. Compared with the other groups, the third tertile group exhibited significantly older age, higher prevalence of diabetes mellitus and hypertension, lower haemoglobin level, and higher N-terminal pro-brain natriuretic peptide level (all P < 0.05). The functional CRT response rate was also significantly lower in the third tertile group (P = 0.011). During a median follow-up of 30 months (inter-quartile range, 9-67), 105 patients (37.1%) died. Kaplan-Meier analysis revealed that patients with a higher MELD-XI score had a greater risk of all-cause mortality (log-rank test: P < 0.001). Even after adjustment for clinically relevant factors and a conventional risk score, the MELD-XI score was still associated with mortality (adjusted hazard ratio: 1.04, 95% confidence interval: 1.00-1.07, P = 0.014, and adjusted hazard ratio: 1.04, 95% confidence interval: 1.01-1.09, P = 0.005, respectively). A higher MELD-XI score was associated with a greater risk of all-cause mortality than a lower MELD-XI score regardless of whether a pacemaker or defibrillator was implanted (log-rank test: P = 0.010 and P < 0.001, respectively). Conclusions Impaired hepatorenal function assessed by the MELD-XI score was associated with older age, higher prevalence of multiple co-morbidities, severity of HF, lower CRT response rates, and subsequent all-cause mortality in HF patients undergoing CRT implantation. These results suggest that the MELD-XI score can provide additional prognostic information and may be useful for improving risk stratification in this population.

The model for end-stage liver disease excluding international normalized ratio (MELD-XI) predicts three-year mortality in patients with advanced heart failure

“…Analysed patients in their study group were older (median age 76 years) than in the following study; furthermore, only in 20% of patients reduced LVEF was observed. Saito et al found that a higher MELD-XI score was associated with all-cause mortality during 30 (9-67) months of follow-up in patients with HF undergoing CRT-D[12]. Hepatorenal impairment in this study group was associated with the severity of…”

Prognostic value of non‐alcoholic fatty liver disease fibrosis score in patients undergoing cardiac resynchronization therapy

“…Cardio‐hepatic pathophysiologic process had great research area. Congestive liver dysfunction occur as a result of elevated central pressure and associated mostly poor prognosis in patients with HF 11,12 . On the other hand, the liver plays a central role in controlling many antioxidant and anti‐inflammation systems 13 .…”

“…Congestive liver dysfunction occur as a result of elevated central pressure and associated mostly poor prognosis in patients with HF. 11,12 On the other hand, the liver plays a central role in controlling many antioxidant and anti-inflammation systems. 13 Oxidative tissue injury and chronic inflammation is well known phenomenon in coronary artery disease as well as heart failure and reverse remodeling.…”

The MELD-XI score predicts 3-year mortality in patients with chronic heart failure

“…Recently, it has been noted that the MELD-XI score predicts adverse events in the short term in patients with heart failure with preserved ejection fraction (HFpEF) ( 13 ). In addition, the association of the MELD score with the occurrence of adverse long-term outcomes was also observed in a study in an end-stage heart failure population who received cardiac resynchronization therapy (CRT) ( 14 ). However, there is currently a lack of evidence on the relationship of the MELD-XI score to long-term outcomes in the hospitalized CHF population.…”

“…A total of 465 patients who were first hospitalized due to chronic heart failure from February 2017 to December 2017 from the Department of Geriatrics, the Second Affiliated Hospital of Chongqing Medical University, were enrolled. Chronic heart failure was defined according to the diagnostic criteria established by 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure ( 14 ): (1) Signs and symptoms of heart failure are present; (2) LVEF <50%, or LVEF ≥50% with evidence of cardiac structural and/or functional abnormalities consistent with left ventricular diastolic dysfunction/elevated left ventricular filling pressure.…”