Key result
The VT-LVAD score independently predicted the occurrence of late ventricular arrhythmias in LVAD recipients (OR 4.8; p<0.001), accurately stratifying high-risk patients.
Why the study?
The need for ICD implantation in LVAD recipients is not well studied, and better selection of patients at high risk for late VAs could lead to more targeted ICD implantation or replacement.
Does the VT-LVAD score predict the occurrence of late ventricular arrhythmias in LVAD recipients?
Cohort (n=357)
No
Does the VT-LVAD score predict the occurrence of late ventricular arrhythmias in LVAD recipients?
The VT-LVAD score accurately predicts late ventricular arrhythmias in high-risk LVAD recipients, supporting its utility for targeted ICD implantations.
May guide ICD decisions in high-risk LVAD recipients; leaves open prospective validation before practice change.
OBJECTIVES: This study sought to validate the performance of the VT-LVAD risk model in predicting late ventricular arrhythmias (VAs) in patients after left ventricular assist device (LVAD) implantation. BACKGROUND: The need for implantable cardioverter-defibrillator (ICD)-implantation in LVAD recipients is not well studied. A better selection of the patients with high risk for late VAs could lead to a more targeted ICD-implantation or replacement. METHODS: The study evaluated the performance of the VT-LVAD prognostic score (VAs prior LVAD, no ACE-inhibitor in medication, heart failure duration > 12 months, early VAs post-LVAD implantation, atrial fibrillation prior LVAD, idiopathic dilated cardiomyopathy) for the endpoint of the occurrence of late VAs in 357 LVAD patients in Heart Centre of Leipzig. RESULTS: From the initial 460 patients, 357 (age: 58 ± 10 years; left ventricular ejection fraction: 20 ± 6%; HeartWare: 50%; HeartMate III: 42%) were assigned to four risk groups according to their VT-LVAD score varying from low risk to very high risk. After 25 months, late VAs occurred in 130 patients. The VT-LVAD score was an independent predictor of late VAs (multivariate analysis; p = < .001; goodness-of-tip p = .347; odds ratio: 4.8). While there was no statistically significant difference between the low- and intermediate-risk group, risk stratification for patients with high risk and very high risk performed more accurately (pairwise comparison p = .005 and p < .001, respectively). CONCLUSIONS: The VT-LVAD score predicted accurately the occurrence of late VAs in high-risk LVAD recipients in a large external cohort of LVAD recipients supporting its utility for more targeted ICD implantations.
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Darma et al. (2020) conducted a cohort in LVAD recipients (n=357). VT-LVAD score was evaluated on occurrence of late VAs (OR 4.8, p=<.001). The VT-LVAD score independently predicted the occurrence of late ventricular arrhythmias in LVAD recipients (OR 4.8; p<0.001), accurately stratifying high-risk patients.
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