Key result
Six-month post-CRT clinical scores like 6MWD outperform LVEF in predicting event-free survival.
Why the study?
LVEF is commonly used to estimate prognosis after CRT, but whether clinical scores assessed at follow-up provide complementary prognostic information was uncertain.
Do clinical scores assessed at 6 months post-CRT improve long-term survival prediction compared to LVEF alone in patients undergoing CRT?
Cohort (n=528)
Do clinical scores assessed at 6 months post-CRT improve long-term survival prediction compared to LVEF alone in patients undergoing CRT?
Effect estimate: C-index 0.767 (6MWD) vs 0.732 (LVEF)
Clinical scores such as 6MWD and frailty indices assessed at 6 months post-CRT provide incremental prognostic value for long-term survival beyond LVEF alone.
6-month clinical scores may improve post-CRT prognostication over LVEF; hypothesis-generating and requires prospective validation before practice change.
Background: Left ventricular ejection fraction (LVEF) is commonly used to characterize remodeling and estimate prognosis after cardiac resynchronization therapy (CRT) .Clinical scores assessed at follow-up may provide complementary prognostic information.Objectives: This study compared the predictive value of LVEF and clinical scores, measured at six months following CRT, for long-term survival.Methods: This prospective cohort study enrolled 528 patients undergoing CRT between May 2016 and June 2022.Clinical scores, including the 6-Minute Walk Distance (6MWD), Gait Speed, the Timed Up and Go Test (TUG), the Study of Osteoporotic Fractures Frailty Index (SOF), and the 5-level EuroQol-5 Dimension score (EQ-5D-5L), were evaluated at six months post-CRT alongside LVEF.The primary endpoint was event-free survival, defined as survival without LVAD implantation, heart transplantation, or death.Using a nested model approach, Cox proportional hazards models assessed predictive accuracy using the concordance index (C-index).Results: Over a mean follow-up of 3.73 years, 127 patients (24%) reached the primary endpoint.In models adjusted for baseline covariates, LVEF at 6 months was associated with event-free survival (C-index=0.732),while several clinical scores showed higher discrimination (C-index for: 6MWD=0.767;SOF=0.754;TUG=0.749;EQ-5D-5L=0.740).Findings were consistent when using clinically relevant cut-points.In LVEF-adjusted models, high-performing clinical measures provided incremental prognostic value beyond LVEF.Conclusions: While LVEF remains a valuable metric, a multidimensional approach incorporating clinical scores alongside LVEF may improve long-term survival prediction following CRT.Their integration into clinical practice could enhance personalized care and risk stratification for CRT recipients.
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Demian et al. (2026) conducted a cohort in Patients undergoing cardiac resynchronization therapy (CRT) (n=528). Clinical scores (6MWD, Gait Speed, TUG, SOF, EQ-5D-5L) vs. Left ventricular ejection fraction (LVEF) was evaluated on Event-free survival (survival without LVAD implantation, heart transplantation, or death) (C-index 0.767 (6MWD) vs 0.732 (LVEF)). Clinical scores assessed 6 months post-CRT, such as 6-Minute Walk Distance (C-index 0.767), provided higher discrimination for event-free survival than LVEF (C-index 0.732).
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