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

Research output: Contribution to journalArticle

Abstract

Background: Almost 1/3 of heart failure patients fail to respond to cardiac resynchronization therapy (CRT). A simple clinical score to predict who these patients are at the moment of referral or at time of implant may be of importance for early optimization of their management. Methods: Observational study. A risk score was derived from factors associated to CRT response. The derivation cohort was composed of 1301 patients implanted with a CRT defibrillator in a multi-center French cohort-study. External validation of this score and assessment of its association with CRT response and all-cause mortality and/or heart transplant was performed in 1959 CRT patients implanted in 4 high-volume European centers. Results: Independent predictors of CRT response in the derivation cohort were: female gender (OR = 2.08, 95% CI 1.26–3.45), NYHA class ≤ III (OR = 2.71, 95% CI 1.63–4.52), left ventricular ejection fraction ≥ 25% (OR = 1.75, 95% CI 1.27–2.41), QRS duration ≥ 150 ms (OR = 1.70, 95% CI 1.25–2.30) and estimated glomerular filtration rate ≥ 60 mL/min (OR = 2.01, 95% CI 1.48–2.72). Each was assigned 1 point. External validation showed good calibration (Hosmer–Lemeshow test-P = 0.95), accuracy (Brier score = 0.19) and discrimination (c-statistic = 0.67), with CRT response increasing progressively from 37.5% in patients with a score of 0 to 91.9% among those with score of 5 (Gamma for trend = 0.44, P < 0.001). Similar results were observed regarding all-cause mortality or heart transplant. Conclusion: The ScREEN score (Sex category, Renal function, ECG/QRS width, Ejection fraction and NYHA class) is composed of widely validated, easy to obtain predictors of CRT response, and predicts CRT response and overall mortality. It should be helpful in facilitating early consideration of alternative therapies for predicted non-responders to CRT therapy.

Details

Authors
  • Rui Providencia
  • Eloi Marijon
  • Sergio Barra
  • Christian Reitan
  • Alexander Breitenstein
  • Pascal Defaye
  • Nikolaos Papageorgiou
  • Rudolph Duehmke
  • Stephan Winnik
  • Richard Ang
  • Didier Klug
  • Daniel Gras
  • Tardu Oezkartal
  • Oliver R. Segal
  • Jean Claude Deharo
  • Christophe Leclercq
  • Pier D. Lambiase
  • Laurent Fauchier
  • Pierre Bordachar
  • Jan Steffel
  • Nicolas Sadoul
  • Olivier Piot
  • Rasmus Borgquist
  • Sharad Agarwal
  • Anthony Chow
  • Serge Boveda
  • DAI-PP Investigators
Organisations
External organisations
  • St Bartholomew's Hospital
  • Nouvelles Cliniques Nantaises
  • University College London
  • Hôpital Européen Georges-Pompidou
  • University Hospital of Zurich
  • Grenoble University Hospital
  • Lille University Hospital
  • La Timone University Hospital
  • University Hospital of Tours
  • Hopital Haut-Leveque C.H.U de Bordeaux
  • University Hospital of Nancy
  • Clinique Pasteur, Toulouse
  • Paris Descartes University
  • Papworth Hospital
  • Rennes University Hospital
  • Centre Cardiologique du Nord, Saint Denis
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems

Keywords

  • DAI-PP, Heart failure, Mortality, Responders, Risk stratification, Score
Original languageEnglish
Pages (from-to)82-87
Number of pages6
JournalInternational Journal of Cardiology
Volume260
Publication statusPublished - 2018 Jun 1
Publication categoryResearch
Peer-reviewedYes