Key result
MADIT-ICD benefit score matches multidisciplinary expert judgment in predicting VT/VF and non-arrhythmic mortality.
Why the study?
The ability of the MADIT-ICD benefit score to predict which HFrEF patients benefit most from adding ICD to CRT and its comparison with expert centre selection was evaluated.
Does the MADIT-ICD benefit score predict which HFrEF patients benefit most from the addition of an ICD to CRT as effectively as a multidisciplinary expert centre approach?
Cohort (n=475)
No
Does the MADIT-ICD benefit score predict which HFrEF patients benefit most from the addition of an ICD to CRT as effectively as a multidisciplinary expert centre approach?
The MADIT-ICD benefit score is comparable to multidisciplinary expert judgment in identifying HFrEF patients who will benefit most from the addition of an ICD to CRT.
May support MADIT-ICD score for CRT-D selection in HFrEF; extends validation to real-world CRT but needs prospective confirmation.
AIMS: The aim of this study is to evaluate whether the MADIT-ICD benefit score can predict who benefits most from the addition of implantable cardioverter-defibrillator (ICD) to cardiac resynchronization therapy (CRT) in real-world patients with heart failure with reduced ejection fraction (HFrEF) and to compare this with selection according to a multidisciplinary expert centre approach. METHODS AND RESULTS: Consecutive HFrEF patients who received a CRT for a guideline indication at a tertiary care hospital (Ziekenhuis Oost-Limburg, Genk, Belgium) between October 2008 and September 2016, were retrospectively evaluated. The MADIT-ICD benefit groups (low, intermediate, and high) were compared with the current multidisciplinary expert centre approach. Endpoints were (i) sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and (ii) non-arrhythmic mortality. Of the 475 included patients, 165 (34.7%) were in the lowest, 220 (46.3%) in the intermediate, and 90 (19.0%) in the highest benefit group. After a median follow-up of 34 months, VT/VF occurred in 3 (1.8%) patients in the lowest, 9 (4.1%) in the intermediate, and 13 (14.4%) in the highest benefit group (P < 0.001). Vice versa, non-arrhythmic death occurred in 32 (19.4%) in the lowest, 32 (14.6%) in the intermediate, and 3 (3.3%) in the highest benefit group (P = 0.002). The predictive power for ICD benefit was comparable between expert multidisciplinary judgement and the MADIT-ICD benefit score: Uno's C-statistic 0.69 vs. 0.69 (P = 0.936) for VT/VF and 0.62 vs. 0.60 (P = 0.790) for non-arrhythmic mortality. CONCLUSION: The MADIT-ICD benefit score can identify who benefits most from CRT-D and is comparable with multidisciplinary judgement in a CRT expert centre.
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Dauw et al. (2022) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=475). MADIT-ICD benefit score vs. Multidisciplinary expert centre approach was evaluated on Predictive power for VT/VF (Uno's C-statistic) (p=0.936). The MADIT-ICD benefit score demonstrated comparable predictive power to multidisciplinary expert judgement for VT/VF (C-statistic 0.69 vs. 0.69; P=0.936) and non-arrhythmic mortality.
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