Nomogram-Based Prediction of Mortality after Cardiac Resynchronization Therapy in Patients with Heart Failure

Heart failure (HF) with reduced ejection fraction (HFrEF; LVEF ≤ 35%) affects more than 64 million people globally.The 5-year all-cause mortality exceeds 40% among this population [1].CRT is a cornerstone treatment for patients with HFrEF with left bundle branch block, prolonged QRS complex duration (ventricular depolarization interval ≥ 150 ms on an electrocardiogram), and New York Heart Association (NYHA) class II-IV symptoms despite optimal medical therapy [2].However, many patients remain at high risk of mortality post-CRT, particularly those who develop new-onset atrial fibrillation (NOAF), which can disrupt resynchronization and worsen prognosis.Existing prognostic models often do not include NOAF and may lack precision in this population [3].This study was aimed at developing and validating a predictive nomogram incorporating NOAF and other clinical variables to improve risk stratification in CRT recipients.What is the Scientific Question Being Addressed?This study evaluates whether a concise prognostic model incorporating peri-procedural new-onset atrial fibrillation (NOAF) and routine clinical variables might improve mortality risk stratification in patients with heart failure undergoing cardiac resynchronization therapy (CRT).What is the Main Novel Finding?A six-variable nomogram -comprising patient age, New York Heart Association (NYHA) class, serum sodium, platelet count, guidelinedirected medical therapy intensity, and periprocedural NOAF -achieved area under the receiver operating characteristic curve values of 0.94-0.99 for 12-36-month mortality, thus providing the first CRT risk model formally incorporating NOAF.This retrospective cohort study, conducted at the First Affiliated Hospital of Xinjiang Medical University, included 563 patients who underwent CRT between January 2018 and December 2023.Eligible patients were ≥18 years of age, had HFrEF,