Predictors of mortality, LVAD implant, or heart transplant in primary prevention cardiac resynchronization therapy recipients: The HF-CRT score

Victor Nauffal, Tanyanan Tanawuttiwat, Yiyi Zhang, John Rickard, Joseph E. Marine, Barbara Butcher, Sanaz Norgard, Timm Dickfeld, Kenneth A. Ellenbogen, Eliseo Guallar, Gordon F. Tomaselli, Alan Cheng

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Cardiac resynchronization therapy (CRT) reduces morbidity and mortality among individuals with dyssynchronous systolic heart failure (HF). However, patient outcomes vary, with some at higher risk than others for HF progression and death. Objective To develop a risk prediction score incorporating variables associated with mortality, left ventricular assist device (LVAD) implant, or heart transplant in recipients of a primary prevention cardiac resynchronization therapy-defibrillator (CRT-D). Methods We followed 305 CRT-D patients from the Prospective Observational Study of Implantable Cardioverter-Defibrillators for the composite outcome of all-cause mortality, LVAD implant, or heart transplant soon after device implantation. Serum biomarkers and electrocardiographic and clinical variables were collected at implant. Multivariable analysis using the Cox proportional hazards model with stepwise selection method was used to fit the final model. Results Among 305 patients, 53 experienced the composite endpoint. In multivariable analysis, 5 independent predictors ("HF-CRT") were identified: high-sensitivity C-reactive protein >9.42 ng/L (HR = 2.5 [1.4, 4.5]), New York Heart Association functional class III/IV (HR = 2.3 [1.2, 4.5]), creatinine >1.2 mg/dL (HR = 2.7 [1.4, 5.1]), red blood cell count <4.3 × 106/μL (HR = 2.4 [1.3, 4.7]), and cardiac troponin T >28 ng/L (HR = 2.7 [1.4, 5.2]). One point was attributed to each predictor and 3 score categories were identified. Patients with scores 0-1, 2-3, and 4-5 had a 3-year cumulative event-free survival of 96.8%, 79.7%, and 35.2%, respectively (log-rank, P <.001). Conclusion A simple score combining clinical and readily available biomarker data can risk-stratify CRT patients for HF progression and death. These findings may help identify patients who are in need of closer monitoring or early application of more aggressive circulatory support.

Original languageEnglish (US)
Pages (from-to)2387-2394
Number of pages8
JournalHeart Rhythm
Volume12
Issue number12
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

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Cardiac Resynchronization Therapy
Heart-Assist Devices
Primary Prevention
Heart Failure
Transplants
Mortality
Biomarkers
Systolic Heart Failure
Erythrocyte Count
Defibrillators
Implantable Defibrillators
Proportional Hazards Models
C-Reactive Protein
Disease-Free Survival
Observational Studies
Creatinine
Prospective Studies
Morbidity
Equipment and Supplies
Serum

Keywords

  • Cardiac resynchronization therapy
  • Heart failure
  • Heart transplant
  • Left ventricular assist device
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Predictors of mortality, LVAD implant, or heart transplant in primary prevention cardiac resynchronization therapy recipients : The HF-CRT score. / Nauffal, Victor; Tanawuttiwat, Tanyanan; Zhang, Yiyi; Rickard, John; Marine, Joseph E.; Butcher, Barbara; Norgard, Sanaz; Dickfeld, Timm; Ellenbogen, Kenneth A.; Guallar, Eliseo; Tomaselli, Gordon F.; Cheng, Alan.

In: Heart Rhythm, Vol. 12, No. 12, 01.12.2015, p. 2387-2394.

Research output: Contribution to journalArticle

Nauffal, V, Tanawuttiwat, T, Zhang, Y, Rickard, J, Marine, JE, Butcher, B, Norgard, S, Dickfeld, T, Ellenbogen, KA, Guallar, E, Tomaselli, GF & Cheng, A 2015, 'Predictors of mortality, LVAD implant, or heart transplant in primary prevention cardiac resynchronization therapy recipients: The HF-CRT score', Heart Rhythm, vol. 12, no. 12, pp. 2387-2394. https://doi.org/10.1016/j.hrthm.2015.07.026
Nauffal, Victor ; Tanawuttiwat, Tanyanan ; Zhang, Yiyi ; Rickard, John ; Marine, Joseph E. ; Butcher, Barbara ; Norgard, Sanaz ; Dickfeld, Timm ; Ellenbogen, Kenneth A. ; Guallar, Eliseo ; Tomaselli, Gordon F. ; Cheng, Alan. / Predictors of mortality, LVAD implant, or heart transplant in primary prevention cardiac resynchronization therapy recipients : The HF-CRT score. In: Heart Rhythm. 2015 ; Vol. 12, No. 12. pp. 2387-2394.
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abstract = "Background Cardiac resynchronization therapy (CRT) reduces morbidity and mortality among individuals with dyssynchronous systolic heart failure (HF). However, patient outcomes vary, with some at higher risk than others for HF progression and death. Objective To develop a risk prediction score incorporating variables associated with mortality, left ventricular assist device (LVAD) implant, or heart transplant in recipients of a primary prevention cardiac resynchronization therapy-defibrillator (CRT-D). Methods We followed 305 CRT-D patients from the Prospective Observational Study of Implantable Cardioverter-Defibrillators for the composite outcome of all-cause mortality, LVAD implant, or heart transplant soon after device implantation. Serum biomarkers and electrocardiographic and clinical variables were collected at implant. Multivariable analysis using the Cox proportional hazards model with stepwise selection method was used to fit the final model. Results Among 305 patients, 53 experienced the composite endpoint. In multivariable analysis, 5 independent predictors ({"}HF-CRT{"}) were identified: high-sensitivity C-reactive protein >9.42 ng/L (HR = 2.5 [1.4, 4.5]), New York Heart Association functional class III/IV (HR = 2.3 [1.2, 4.5]), creatinine >1.2 mg/dL (HR = 2.7 [1.4, 5.1]), red blood cell count <4.3 × 106/μL (HR = 2.4 [1.3, 4.7]), and cardiac troponin T >28 ng/L (HR = 2.7 [1.4, 5.2]). One point was attributed to each predictor and 3 score categories were identified. Patients with scores 0-1, 2-3, and 4-5 had a 3-year cumulative event-free survival of 96.8{\%}, 79.7{\%}, and 35.2{\%}, respectively (log-rank, P <.001). Conclusion A simple score combining clinical and readily available biomarker data can risk-stratify CRT patients for HF progression and death. These findings may help identify patients who are in need of closer monitoring or early application of more aggressive circulatory support.",
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T1 - Predictors of mortality, LVAD implant, or heart transplant in primary prevention cardiac resynchronization therapy recipients

T2 - The HF-CRT score

AU - Nauffal, Victor

AU - Tanawuttiwat, Tanyanan

AU - Zhang, Yiyi

AU - Rickard, John

AU - Marine, Joseph E.

AU - Butcher, Barbara

AU - Norgard, Sanaz

AU - Dickfeld, Timm

AU - Ellenbogen, Kenneth A.

AU - Guallar, Eliseo

AU - Tomaselli, Gordon F.

AU - Cheng, Alan

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Background Cardiac resynchronization therapy (CRT) reduces morbidity and mortality among individuals with dyssynchronous systolic heart failure (HF). However, patient outcomes vary, with some at higher risk than others for HF progression and death. Objective To develop a risk prediction score incorporating variables associated with mortality, left ventricular assist device (LVAD) implant, or heart transplant in recipients of a primary prevention cardiac resynchronization therapy-defibrillator (CRT-D). Methods We followed 305 CRT-D patients from the Prospective Observational Study of Implantable Cardioverter-Defibrillators for the composite outcome of all-cause mortality, LVAD implant, or heart transplant soon after device implantation. Serum biomarkers and electrocardiographic and clinical variables were collected at implant. Multivariable analysis using the Cox proportional hazards model with stepwise selection method was used to fit the final model. Results Among 305 patients, 53 experienced the composite endpoint. In multivariable analysis, 5 independent predictors ("HF-CRT") were identified: high-sensitivity C-reactive protein >9.42 ng/L (HR = 2.5 [1.4, 4.5]), New York Heart Association functional class III/IV (HR = 2.3 [1.2, 4.5]), creatinine >1.2 mg/dL (HR = 2.7 [1.4, 5.1]), red blood cell count <4.3 × 106/μL (HR = 2.4 [1.3, 4.7]), and cardiac troponin T >28 ng/L (HR = 2.7 [1.4, 5.2]). One point was attributed to each predictor and 3 score categories were identified. Patients with scores 0-1, 2-3, and 4-5 had a 3-year cumulative event-free survival of 96.8%, 79.7%, and 35.2%, respectively (log-rank, P <.001). Conclusion A simple score combining clinical and readily available biomarker data can risk-stratify CRT patients for HF progression and death. These findings may help identify patients who are in need of closer monitoring or early application of more aggressive circulatory support.

AB - Background Cardiac resynchronization therapy (CRT) reduces morbidity and mortality among individuals with dyssynchronous systolic heart failure (HF). However, patient outcomes vary, with some at higher risk than others for HF progression and death. Objective To develop a risk prediction score incorporating variables associated with mortality, left ventricular assist device (LVAD) implant, or heart transplant in recipients of a primary prevention cardiac resynchronization therapy-defibrillator (CRT-D). Methods We followed 305 CRT-D patients from the Prospective Observational Study of Implantable Cardioverter-Defibrillators for the composite outcome of all-cause mortality, LVAD implant, or heart transplant soon after device implantation. Serum biomarkers and electrocardiographic and clinical variables were collected at implant. Multivariable analysis using the Cox proportional hazards model with stepwise selection method was used to fit the final model. Results Among 305 patients, 53 experienced the composite endpoint. In multivariable analysis, 5 independent predictors ("HF-CRT") were identified: high-sensitivity C-reactive protein >9.42 ng/L (HR = 2.5 [1.4, 4.5]), New York Heart Association functional class III/IV (HR = 2.3 [1.2, 4.5]), creatinine >1.2 mg/dL (HR = 2.7 [1.4, 5.1]), red blood cell count <4.3 × 106/μL (HR = 2.4 [1.3, 4.7]), and cardiac troponin T >28 ng/L (HR = 2.7 [1.4, 5.2]). One point was attributed to each predictor and 3 score categories were identified. Patients with scores 0-1, 2-3, and 4-5 had a 3-year cumulative event-free survival of 96.8%, 79.7%, and 35.2%, respectively (log-rank, P <.001). Conclusion A simple score combining clinical and readily available biomarker data can risk-stratify CRT patients for HF progression and death. These findings may help identify patients who are in need of closer monitoring or early application of more aggressive circulatory support.

KW - Cardiac resynchronization therapy

KW - Heart failure

KW - Heart transplant

KW - Left ventricular assist device

KW - Mortality

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