A Clinical Prediction Rule to Identify Patients at Heightened Risk for Early Demise Following Cardiac Resynchronization Therapy

作者：Rickard John^*; Cheng Alan; Spragg David; Cantillon Daniel; Baranowski Bryan; Varma Niraj; Wilkoff Bruce L; Tang W H Wilson

来源：Journal of Cardiovascular Electrophysiology, 2014, 25(3): 278-282.

DOI：10.1111/jce.12344

• cardiac resynchronization therapy
• heart failure
• implantable cardiac defibrillator
• left bundle branch block
• mortality

Prediction Rule to Identify Patients at High Risk for Early Demise Following CRT
BackgroundIn patients with advanced heart failure, the decision of whether to pursue cardiac resynchronization therapy (CRT) or to proceed directly to advanced heart failure therapies can be challenging. We sought to create a prediction rule to identify patients with advanced systolic heart failure at heightened risk of rapid deterioration despite receiving CRT.
MethodsClinical data were collected on consecutive patients with advanced heart failure presenting for a new CRT device at the Cleveland Clinic between February 12, 2002 and July 8, 2008. Early demise was defined as death, left ventricular assist device, or heart transplant within 6 months following CRT implant. Using a multivariate model, variables associated with early demise were identified and a prediction rule created.
ResultsA total of 879 patients were included of whom 47 met criteria for early demise. Using forward stepwise regression followed by a bootstrapping analysis, the final model included: left ventricular end-diastolic diameter 6.5cm (OR 3.23 [1.72-6.06 g], P < 0.001), the presence of a non-left bundle branch block (non-LBBB) morphology (OR 2.18 [1.18-4.04, P = 0.013]), creatinine 1.5 mg/dL (OR 2.98 [1.52-5.49], P < 0.001), and lack of or intolerance to -blocker use (OR 2.80 [1.46-5.39], P = 0.002). The specificity for 2 and 3 risk factors was 72.6% and 94.6%, respectively.
ConclusionsLeft ventricular dilatation, the presence of a non-LBBB morphology, renal dysfunction, and lack of or intolerance to -blockers are associated with early demise following CRT. In patients with at least 3 of these factors, bypassing CRT with early adoption of advanced heart failure therapies may be considered given the high specificity for rapid decline.

• 出版日期2014-3