Key result
A 4-variable score predicts ~2-fold higher mortality per point in mild HF with LBBB receiving CRT-D.
Why the study?
Does a clinical risk score predict mortality and identify patients with mild heart failure and LBBB who benefit most from CRT-D compared to ICD?
Cohort (n=756)
Yes
Does a clinical risk score predict mortality and identify patients with mild heart failure and LBBB who benefit most from CRT-D compared to ICD?
A simple 4-variable clinical risk score can stratify mortality risk and identify which patients with mild heart failure and LBBB derive the most survival benefit from CRT-D compared to ICD.
May aid mortality stratification in mild HF with LBBB; hypothesis-generating for CRT-D benefit and requires prospective validation.
BACKGROUND: Cardiac resynchronization therapy (CRT) is highly beneficial in patients with heart failure (HF) and left bundle branch block (LBBB); however, up to 30% of patients in this selected group are nonresponders. HYPOTHESIS: We hypothesized that clinical and echocardiographic variables can be used to develop a simple mortality risk stratification score in CRT. METHODS: Best-subsets proportional-hazards regression analysis was used to develop a simple clinical risk score for all-cause mortality in 756 patients with LBBB allocated to the CRT with defibrillator (CRT-D) group enrolled in the multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy. The score was used to assess the mortality risk within the CRT-D group and the associations with mortality reduction with CRT-D vs implantable cardioverter defibrillator (ICD) in each risk category. RESULTS: Four clinical variables comprised the risk score: age ≥ 65, creatinine ≥ 1.4 mg/dL, history of coronary artery bypass graft, and left ventricular ejection fraction (LVEF) < 26%. Every 1 point increase in the score was associated with 2-fold increased mortality within the CRT-D arm (P < 0.001). CRT-D was associated with mortality reduction as compared with ICD only in patients with moderate risk: score 0 (HR = 0.80, P = 0.615), score 1 (HR = 0.54, P = 0.019), score 2 (HR = 0.54, P = 0.016), score 3-4 risk factors (HR = 1.08, P = 0.811); however, the device by score interaction was not significant (P = 0.306). The score was also significantly predictive of left ventricular reverse remodeling (P < 0.001). CONCLUSIONS: Four clinical variables can be used for improved mortality risk stratification in mild HF patients with LBBB implanted with CRT-D.
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Biton et al. (2018) conducted a cohort in Mild heart failure with left bundle branch block (n=756). Cardiac resynchronization therapy with defibrillator (CRT-D) vs. Implantable cardioverter defibrillator (ICD) was evaluated on All-cause mortality. A 4-variable clinical risk score predicted mortality in mild heart failure patients with LBBB receiving CRT-D, with each 1-point increase associated with a 2-fold increased mortality (P<0.001).
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