Usefulness of a clinical risk score to predict the response to cardiac resynchronization therapy

Providência, Rui; Marijon, Éloi; Barra, Sérgio; Reitan, Christian; Berndt, Alexander; Defaye, Pascal; Papageorgiou, Nikolaos S.; Duehmke, Rudolph; Winnik, Stephan; Ang, Richard; Klug, Didier; Gras, Daniel; Oezkartal, T; Segal, Oliver R.; Deharo, Jean Claude; Leclercq, Christophe; Lambiase, Pier D.; Fauchier, Laurent; Bordachar, Pierre; Steffel, Jan; Sadoul, Nicolas; Piot, Olivier; Borgquist, Rasmus; Agarwal, Sharad; Chow, Anthony; Boveda, Serge; Investigators, Dai-Pp

doi:10.1016/j.ijcard.2018.02.012

Cited by 26 publications

(39 citation statements)

References 32 publications

(23 reference statements)

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“…Since not every heart failure patient seems to benefit from CRT, major efforts have been made to identify predictors for CRT response. Recently, a simple risk score has been derived from a French multi-centre cohort and then validated in four high-volume European centres [15]. CRT response was defined as an improvement of !1 NYHA functional class and/or !5% left ventricular ejection fraction (LVEF) in the absence of hospitalization for congestive heart failure within the 12 months after implant.…”

Section: Traditional Determinants Of Crt Responsementioning

confidence: 99%

Non-invasive cardiac mapping for non-response in cardiac resynchronization therapy

et al. 2019

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Cardiac resynchronization therapy (CRT) is an effective intervention in selected patients with moderate-to-severe heart failure with reduced ejection fraction and abnormal left ventricular activation time. The non-response rate of approximately 30% has remained nearly unchanged since this therapy was introduced 25 years ago. While intracardiac mapping is widely used for diagnosis and guidance of therapy in patients with tachyarrhythmia, its application in characterization of the electrical substrate to elucidate the mechanisms involved in CRT response remain anecdotal. In the present review, we describe the traditional determinants of CRT response before presenting novel non-invasive techniques used for CRT optimization. We discuss efforts to identify the target electrical substrate to guide the deployment of pacing electrodes during the operative procedure. Non-invasive body surface mapping technologies such as ECG imaging or ECG belt enables prediction of acute and chronic CRT response. While electrical dyssynchrony parameters provide high predictive accuracy for CRT response when obtained during intrinsic conduction, their predictive value is less when acquired during CRT or LV-pacing. KEY MESSAGES Classic predictors of CRT response are female gender, NYHA class III, left ventricular ejection fraction !25%, QRS duration !150 ms and estimated glomerular filtration rate !60 mL/min. ECG-imaging is a comprehensive non-invasive mapping system which allows to express the amount of electrical asynchrony of a CRT candidate. Non-invasive body surface mapping technologies enables excellent prediction of acute and chronic CRT response before implantation. When performed during CRT or LV-pacing, the added value of these mapping systems remains unclear.

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Section: Traditional Determinants Of Crt Responsementioning

confidence: 99%

Non-invasive cardiac mapping for non-response in cardiac resynchronization therapy

et al. 2019

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“…We reported here for the first time that NYHA class ≥III at the time of implantation was associated with CRT response in the ≥75-year-old individuals but not in younger patients. Conversely, a recent study showed that NYHA class ≤III was an independent predictor of CRT benefit in a mid-sixties population [20]. In contrast, AF has been associated with poor results of CRT [21].…”

Section: Discussionmentioning

confidence: 96%

Predictors of clinical outcomes after cardiac resynchronization therapy in patients ≥75 years of age: a retrospective cohort study

Champ‐Rigot

Cornille

Ollitrault

et al. 2019

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Background: Cardiac resynchronization therapy has been shown to benefit selected patients with heart failure and reduced ejection fraction. Older patients have been underrepresented in randomized trials. This study was conducted to determine whether predictive factors for cardiac resynchronization therapy outcomes differ in patients older and younger than 75 years of age. Methods: Consecutive patients who received a cardiac resynchronization device cardiac resynchronization therapy between 2013 and 2016 in our center were retrospectively included in this cohort study. The primary endpoint was cardiac resynchronization therapy effectiveness, which was defined as survival for one year with both no heart failure hospitalization and improvement by one or more NYHA class. The secondary endpoints were mortality, complications, and device therapies. Results: Among the 243 patients included, 102 were ≥75 years old. Cardiac resynchronization therapy effectiveness was observed in 70 patients (50%) <75 years old and in 48 patients (47%) ≥75 years old (p=0.69). NYHA class ≥III (OR=6.02; CI95% [1.33-18.77], p=0.002) was a predictive factor for cardiac resynchronization therapy effectiveness only in the ≥75-year-old group, while atrial fibrillation was independently negatively associated with the primary endpoint in the <75-year-old group (OR=0.28; CI95% [0.13-0.62], p=0.001). The one-year mortality rate was 14%, with no difference between age groups. Rescue cardiac resynchronization therapy and atrial fibrillation were independent predictive factors for mortality in both age groups. Eighty-two complications occurred in 45 patients (19%), with no difference between groups. Defibrillator use and QRS duration were independent predictive factors for complications in both age groups. There was no difference between groups considering device therapies. Conclusion: At one year, cardiac resynchronization therapy response is not compromised by patient age. In older patients, highly symptomatic individuals with NYHA class ≥III have better outcomes after cardiac resynchronization therapy.

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“…Over the past decades, prior risk models [9, 10, 14-16] were derived with good calibration and accuracy in derivation cohorts or Western validation cohorts; however, Asian populations, especially Chinese participants, are rarely used for validation [17]. VALID-CRT [11]and sex category, renal function, ECG/QRS width, ejection fraction, and NYHA class (ScREEN) [8] scores were derived and validated in European multicenter studies, and ejection fraction, atrial fibrillation, age, renal function, and NYHA class (EARRN) [10] does not have a validation population.…”

Section: The Published Scoresmentioning

confidence: 99%

A Novel Risk Model for Mortality and Hospitalization following Cardiac Resynchronization Therapy in Patients with Non-ischemic Cardiomyopathy: The Alpha-score

Yang

Liu

et al. 2020

Preprint

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Background: Non-ischemic cardiomyopathy (NICM) has been associated with a better left ventricle reverse remodeling response and improved clinical outcomes after cardiac resynchronization therapy (CRT). The aims of our study were to identify the predictors of mortality and heart failure hospitalization in patients treated with CRT and design a risk score for prognosis. Methods: A cohort of 422 consecutive NICM patients with CRT was retrospectively enrolled between January 2010 and December 2017. The primary endpoint was all-cause mortality and heart transplantation. Results: In a multivariate analysis, the predictors of all-cause death were left atrial diameter [Hazard ratio (HR): 1.056, 95% confidence interval (CI): 1.020-1.093, P=0.002]; non-left bundle branch block [HR: 1.793, 95% CI: 1.131-2.844, P =0.013]; high sensitivity C-reactive protein [HR: 1.081, 95% CI: 1.029-1.134 P= 0.002]; and N-terminal pro-B-type natriuretic peptide [HR: 1.018, 95% CI: 1.007-1.030, P =0.002]; and New York Heart Association class IV [HR: 1.018, 95% CI: 1.007-1.030, P =0.002]. The Alpha-score ( A trial diameter, non-L BBB, P ro-BNP, H s-CRP, NYH A class IV) was derived from each independent risk factor. The novel score had good calibration (Hosmer-Lemeshow, P >0.05) and discrimination for both primary endpoints [c-statistics: 0.749 (95% CI: 0.694-0.804), P <0.001] or heart failure hospitalization [c-statistics: 0.692 (95% CI: 0.639-0.745), P <0.001]. Conclusion: The Alpha-score may enable improved discrimination and accurate prediction of longterm outcomes among NICM patients with CRT. Background Cardiac resynchronization therapy (CRT) improves cardiac function and decreases hospital admissions and mortality among patients with advanced heart failure (HF) and left ventricular dyssynchrony [1-3]. However, based on data derived from numerous large-sample, randomized trials, approximately one-third of all CRT recipients fail to achieve the expected benefit from the device [4]. Since the implantation of CRT devices is an invasive approach with a relatively high the economic burden, the application of a risk model for candidate stratification could aide in the optimal selection of patients and in identifying eligible patients likely to receive the greatest benefit. Non-ischemic cardiomyopathy Ueyama T, Morita N, Nitta T et al: Trends and determinant factors in the use of cardiac resynchronization therapy devices in Japan: Analysis of the Japan cardiac device treatment registry database. J Arrhythm 2016, 32(6):486-490. 22. Pan C et al: A new score system for predicting response to cardiac resynchronization therapy. Cardiol J 2015, 22(2):179-187. 23.Bleeker GB, Kaandorp TA, Lamb HJ, Boersma E, Steendijk P, de Roos A, van der Wall EE, Schalij MJ, Bax JJ: Effect of posterolateral scar tissue on clinical and

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Usefulness of a clinical risk score to predict the response to cardiac resynchronization therapy

Cited by 26 publications

References 32 publications

Non-invasive cardiac mapping for non-response in cardiac resynchronization therapy

Non-invasive cardiac mapping for non-response in cardiac resynchronization therapy

Predictors of clinical outcomes after cardiac resynchronization therapy in patients ≥75 years of age: a retrospective cohort study

A Novel Risk Model for Mortality and Hospitalization following Cardiac Resynchronization Therapy in Patients with Non-ischemic Cardiomyopathy: The Alpha-score

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