1
|
Galloo X, Khidir M, Stassen J, Hirasawa K, Cosyns B, van der Bijl P, Delgado V, Ajmone Marsan N, Bax JJ. Risk Factors for Short-Term Versus Long-Term Mortality in Patients Who Underwent Cardiac Resynchronization Therapy. Am J Cardiol 2023; 197:34-41. [PMID: 37137252 DOI: 10.1016/j.amjcard.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/23/2023] [Accepted: 03/26/2023] [Indexed: 05/05/2023]
Abstract
Cardiac resynchronization therapy (CRT) is an effective therapy in selected patients with advanced heart failure that reduces all-cause mortality at short-term follow-up. However, data regarding long-term mortality after CRT implantation are scarce, with no separate analysis available of the covariates associated with respectively short-term and long-term outcomes. Accordingly, the present study evaluated the risk factors associated with short-term (2-year follow-up) versus long-term (10-year follow-up) mortality after CRT implantation. Patients who underwent CRT implantation and had echocardiographic evaluation before implantation were included in the present study. The primary end point was all-cause mortality, and independent associates of short-term (2-year follow-up) and long-term (10-year follow-up) mortality were compared. In total, 894 patients (mean age 66 ± 10 years, 76% males) who underwent CRT implantation were included in the present study. The cumulative overall survival rates for the total population were 91%, 71%, and 45% at 2-, 5- and 10-year follow-up, respectively. Multivariable Cox regression analysis showed that short-term mortality was associated with both clinical and echocardiographic variables at the moment of CRT implantation; whereas long-term mortality was predominantly associated with baseline clinical parameters and was less strongly associated with baseline echocardiographic parameters. In conclusion, at long-term (10-year) follow-up, a significant proportion (45%) of patients with advanced heart failure who underwent CRT implantation were still alive. Importantly, the risk assessment for short-term (2-year follow-up) and long-term (10-year follow-up) mortality differ considerably, which may influence clinical decision making.
Collapse
Affiliation(s)
- Xavier Galloo
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Free University Brussels (VUB), University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Mand Khidir
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bernard Cosyns
- Department of Cardiology, Free University Brussels (VUB), University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Heart Institute, Hospital University Germans Trias i Pujol, Badalona, Spain
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland.
| |
Collapse
|
2
|
Boros AM, Perge P, Merkely B, Széplaki G. Risk scores in cardiac resynchronization therapy-A review of the literature. Front Cardiovasc Med 2023; 9:1048673. [PMID: 36733831 PMCID: PMC9886679 DOI: 10.3389/fcvm.2022.1048673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) for selected heart failure (HF) patients improves symptoms and reduces morbidity and mortality; however, the prognosis of HF is still poor. There is an emerging need for tools that might help in optimal patient selection and provide prognostic information for patients and their families. Several risk scores have been created in recent years; although, no literature review is available that would list the possible scores for the clinicians. We identified forty-eight risk scores in CRT and provided the calculation methods and formulas in a ready-to-use format. The reviewed score systems can predict the prognosis of CRT patients; some of them have even provided an online calculation tool. Significant heterogeneity is present between the various risk scores in terms of the variables incorporated and some variables are not yet used in daily clinical practice. The lack of cross-validation of the risk scores limits their routine use and objective selection. As the number of prognostic markers of CRT is overwhelming, further studies might be required to analyze and cross-validate the data.
Collapse
Affiliation(s)
| | - Péter Perge
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Gábor Széplaki
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary,Heart and Vascular Centre, Mater Private Hospital, Dublin, Ireland,Royal College of Surgeons in Ireland, Dublin, Ireland,*Correspondence: Gábor Széplaki,
| |
Collapse
|
3
|
Dong M, Xu C, Zhou J, Yuan Z. Influence of hemoglobin concentration on the in-hospital outcomes in newly diagnosed heart failure patients with atrial fibrillation: Finding from CCC-AF (improving care for cardiovascular disease in China-atrial fibrillation) project. Medicine (Baltimore) 2022; 101:e28978. [PMID: 35244067 PMCID: PMC8896450 DOI: 10.1097/md.0000000000028978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/07/2022] [Indexed: 01/04/2023] Open
Abstract
Atrial fibrillation (AF) and heart failure (HF) coexistence is common of clinical significance. Although anemia is a well-recognized risk factor for adverse outcomes, the prognostic value of hemoglobin is controversial in AF and HF. We aimed to determine whether hemoglobin is associated with in-hospital outcomes in such patients.On the basis of the data from the CCC-AF (Improving Care for Cardiovascular Diseases in China-Atrial Fibrillation) project, 2367 inpatients with a definitive diagnosis of AF and HF and record of admission hemoglobin concentration were included. Logistic regression analysis was performed to investigate the relationship between hemoglobin and in-hospital outcomes.All patients were divided into 4 groups according to quartiles of hemoglobin values. Compared with patients with higher hemoglobin, patients with lower hemoglobin had higher proportion of males, heart rate (HR), and diastolic blood pressure (DBP). On the contrary, they had lower age, medical history, left ventricular ejection fraction (LVEF), and brain natriuretic peptide (P < .05). Spearman correlation showed that hemoglobin was negatively correlated with age, LVEF, international normalized ratio, and serum creatinine but positively correlated with HR, DBP, and blood urea nitrogen (P < .05). Multivariable logistic regression analysis revealed that increasing hemoglobin was an independent protective factor for in-hospital outcomes (odds ratio = 0.989; 95% confidence interval: 0.979-1.000; P = .046).Admission hemoglobin concentration was an independent protective factor for in-hospital outcomes in HF patients with AF. Our study indicated that increasing hemoglobin level and improving anemia degree might improve the prognosis of patients with AF and HF.
Collapse
Affiliation(s)
- Mengya Dong
- Department of Cardiology, Shaanxi Provincial People's Hospital, Shaanxi, China
| | - Chenbo Xu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical College, Xi’an Jiao tong University, Xi’an, Shaanxi, China
| | - Juan Zhou
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical College, Xi’an Jiao tong University, Xi’an, Shaanxi, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
| | - Zuyi Yuan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical College, Xi’an Jiao tong University, Xi’an, Shaanxi, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi’an Jiao tong University, Ministry of Education, Xi’an, Shaanxi, China
| |
Collapse
|
4
|
Chung MK, Fagerlin A, Wang PJ, Ajayi TB, Allen LA, Baykaner T, Benjamin EJ, Branda M, Cavanaugh KL, Chen LY, Crossley GH, Delaney RK, Eckhardt LL, Grady KL, Hargraves IG, Hills MT, Kalscheur MM, Kramer DB, Kunneman M, Lampert R, Langford AT, Lewis KB, Lu Y, Mandrola JM, Martinez K, Matlock DD, McCarthy SR, Montori VM, Noseworthy PA, Orland KM, Ozanne E, Passman R, Pundi K, Roden DM, Saarel EV, Schmidt MM, Sears SF, Stacey D, Stafford RS, Steinberg BA, Wass SY, Wright JM. Shared Decision Making in Cardiac Electrophysiology Procedures and Arrhythmia Management. Circ Arrhythm Electrophysiol 2021; 14:e007958. [PMID: 34865518 PMCID: PMC8692382 DOI: 10.1161/circep.121.007958] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Shared decision making (SDM) has been advocated to improve patient care, patient decision acceptance, patient-provider communication, patient motivation, adherence, and patient reported outcomes. Documentation of SDM is endorsed in several society guidelines and is a condition of reimbursement for selected cardiovascular and cardiac arrhythmia procedures. However, many clinicians argue that SDM already occurs with clinical encounter discussions or the process of obtaining informed consent and note the additional imposed workload of using and documenting decision aids without validated tools or evidence that they improve clinical outcomes. In reality, SDM is a process and can be done without decision tools, although the process may be variable. Also, SDM advocates counter that the low-risk process of SDM need not be held to the high bar of demonstrating clinical benefit and that increasing the quality of decision making should be sufficient. Our review leverages a multidisciplinary group of experts in cardiology, cardiac electrophysiology, epidemiology, and SDM, as well as a patient advocate. Our goal is to examine and assess SDM methodology, tools, and available evidence on outcomes in patients with heart rhythm disorders to help determine the value of SDM, assess its possible impact on electrophysiological procedures and cardiac arrhythmia management, better inform regulatory requirements, and identify gaps in knowledge and future needs.
Collapse
Affiliation(s)
| | - Angela Fagerlin
- University of Utah, Salt Lake City, UT
- Salt Lake City Veterans Affairs Informatics Decision-Enhancement and Analytic Sciences Center for Innovation, Salt Lake City, UT
| | | | | | | | | | | | - Megan Branda
- University of Colorado, Aurora, CO
- Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | | | | | | | - Marleen Kunneman
- Mayo Clinic, Rochester, MN
- Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | - Ying Lu
- Stanford University, Stanford, CA
| | | | | | | | | | | | | | | | | | | | | | - Dan M. Roden
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | | | | - Sojin Youn Wass
- Cleveland Clinic, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | | |
Collapse
|
5
|
Appadurai V, D'Elia N, Mew T, Tomlinson S, Chan J, Hamilton-Craig C, Scalia GM. Global longitudinal strain as a prognostic marker in cardiac resynchronisation therapy: A systematic review. IJC HEART & VASCULATURE 2021; 35:100849. [PMID: 34386575 PMCID: PMC8342974 DOI: 10.1016/j.ijcha.2021.100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/07/2021] [Accepted: 07/22/2021] [Indexed: 12/03/2022]
Abstract
Left ventricular global longitudinal strain (LV GLS) is a sensitive parameter that correlates with myocardial scar burden and fibrosis with potential value in CRT candidates. First systematic review evaluating the existing evidence for the prognostic value of LV GLS in patients undergoing CRT implantation. Despite significantly abnormal baseline GLS at CRT implantation, there is still a significant association between incrementally worse LV GLS at CRT implantation and prognostic outcomes on long-term follow-up.
Purpose Cardiac resynchronisation therapy (CRT) has proven mortality benefits for heart failure patients with moderate to severe systolic left ventricular dysfunction and evidence of a left bundle branch block. Determining responders to this therapy can be difficult due to the presence of myocardial fibrosis and scar. Left ventricular global longitudinal strain (LV GLS) is a robust and sensitive measure of myocardial function and fibrosis that has significant prognostic value for a plethora of cardiac pathologies. Our aim was to perform a systematic review of the value of LV GLS for predicting outcomes in patients undergoing CRT. Methods A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) protocol for reporting on systematic reviews and meta-analyses. An electronic search of all English, adult publications in EMBASE, MEDLINE/PubMed and the Cochrane Database of Systematic reviews was undertaken. Results The search yielded, 9 studies that included 3,981 patients with symptomatic heart failure, undergoing CRT implantation with LV GLS utilised as a predictor of all-cause mortality, cardiovascular death, rehospitalisation, LVAD implantation/ heart transplantation or left ventricular reverse remodelling. Significant heterogeneity was observed in study outcome measures, included populations, LV-GLS cut-offs and follow-up definitions, resulting in the inability to reliably conduct a meta-analyses. Overall, pre-CRT LV GLS was found to be a predictor of outcome post CRT insertion. Conclusions In conclusion, all studies implied that incrementally abnormal baseline LV GLS pre-CRT implantation was associated with a long term poorer outcome.
Collapse
Affiliation(s)
- Vinesh Appadurai
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia.,School of Medicine, The University of Queensland, St Lucia, Australia
| | - Nicholas D'Elia
- The Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Thomas Mew
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia.,School of Medicine, The University of Queensland, St Lucia, Australia
| | - Stephen Tomlinson
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia.,School of Medicine, The University of Queensland, St Lucia, Australia
| | - Jonathan Chan
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia.,School of Medicine, Griffith University, Gold Coast, Australia
| | - Christian Hamilton-Craig
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia.,School of Medicine, The University of Queensland, St Lucia, Australia.,School of Medicine, Griffith University, Gold Coast, Australia
| | - Gregory M Scalia
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia.,School of Medicine, The University of Queensland, St Lucia, Australia
| |
Collapse
|
6
|
Raj A, Nath RK, Pandit BN, Singh AP, Pandit N, Aggarwal P. Comparing the Modified Frailty Index with conventional scores for prediction of cardiac resynchronization therapy response in patients with heart failure. J Frailty Sarcopenia Falls 2021; 6:79-85. [PMID: 34131604 PMCID: PMC8173534 DOI: 10.22540/jfsf-06-079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/11/2022] Open
Abstract
Objective: The aim of the study was to compare, Modified Frailty Index (mFI), EAARN (LVEF <22%, Atrial Fibrillation, Age ≥70 years, Renal function (eGFR <60 mL/min/1.73m2), NYHA class IV), and ScREEN (female Sex, Renal function (eGFR ≥60 mL/min/1.73m2), LVEF ≥25%, ECG (QRS duration ≥150 ms) and NYHA class ≤III) score for predicting cardiac resynchronization therapy (CRT) response and all-cause mortality. Methods: In this prospective, non-randomized, single-center, observational study we enrolled 93 patients receiving CRT from August 2016 to August 2019. Pre-implant scores were calculated, and patients were followed for six months. Performance of each score for prediction of CRT response (defined as ≥15% reduction in left ventricular end-systolic volume [LVESV]) and all-cause mortality was compared. Results: Optimal CRT response was seen in seventy patients with nine deaths. All the three scores exhibited modest performance for prediction of CRT response and all-cause mortality with AUC ranging from 0.608 to 0.701. mFI has an additional benefit for prediction of prolonged post-procedure stay and 30-day rehospitalization events. Conclusion: mFI, ScREEN and EAARN score can be used reliably for predicting all-cause mortality and response to CRT.
Collapse
Affiliation(s)
- Ajay Raj
- Department of Cardiology, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Ranjit Kumar Nath
- Department of Cardiology, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Bhagya Narayan Pandit
- Department of Cardiology, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Ajay Pratap Singh
- Department of Cardiology, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Neeraj Pandit
- Department of Cardiology, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Puneet Aggarwal
- Department of Cardiology, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| |
Collapse
|
7
|
Reitan C, Platonov PG, Borgquist R. The CHA2DS2-VASc Score and Its Association with Long-Term Outcome in a Cardiac Resynchronization Therapy Population. Cardiology 2021; 146:453-463. [PMID: 33965960 DOI: 10.1159/000513955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is commonly used in patients with heart failure and left ventricular dyssynchrony. Several scoring systems have been tested in order to predict long-term outcome. Although intended for use in patients with atrial fibrillation, we sought to assess the performance of the CHA2DS2-VASc score in a CRT population. METHODS Data on 796 consecutive CRT patients were retrospectively gathered from hospital records and healthcare registries. CHA2DS2-VASc scores were calculated, as well as other stratification scores for comparison. The outcomes were crude mortality, time to first heart failure hospitalization, and a composite of the 2. CHA2DS2-VASc score was evaluated against the end points with survival analyses and compared to other risk stratification scores. RESULTS The CHA2DS2-VASc score was significantly correlated with both outcomes in univariable and multivariable analysis adjusting for other known predictors of CRT outcome (unadjusted HR 1.28, 95% CI 1.21-1.36 and HR 1.19, 95% CI 1.13-1.25 for the mortality and heart failure hospitalization end points, respectively). Its performance compared well to other validated scores for the mortality end point (Harrell's C: 0.61, range for other scoring systems: 0.57-0.65), as well as the heart failure hospitalization end point (Harrell's C: 0.57, range of other scoring systems: 0.58-0.62). It correlated to 5- and 10-year survival with an area under the curve of 0.63 and 0.73, respectively. CONCLUSION When tested for association with outcome in a CRT population, the CHA2DS2-VASc score correlates to increased mortality and risk of heart failure hospitalization. It performs similarly to CRT-specific scores. However, the results of this study indicate that all tested scores should be used with caution in CRT patients.
Collapse
Affiliation(s)
- Christian Reitan
- Department of Cardiology, Institution for Clinical Sciences, Lund University, Lund, Sweden.,Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.,Danderyd University Hospital, Danderyd, Sweden
| | - Pyotr G Platonov
- Department of Cardiology, Institution for Clinical Sciences, Lund University, Lund, Sweden.,Arrhythmia Department, Scania University Hospital, Lund, Sweden
| | - Rasmus Borgquist
- Department of Cardiology, Institution for Clinical Sciences, Lund University, Lund, Sweden.,Arrhythmia Department, Scania University Hospital, Lund, Sweden
| |
Collapse
|
8
|
Kim WH, Kim JT. Machine learning-based mortality prediction: how to be connected to daily clinical practice? Eur Heart J 2021; 41:2913. [PMID: 32607586 DOI: 10.1093/eurheartj/ehaa264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| |
Collapse
|
9
|
Device Adjustment and Recovery in Patients With Heart Failure Undergoing a Cardiac Resynchronization Therapy Implantation: A Longitudinal Study. J Cardiovasc Nurs 2021; 37:221-230. [PMID: 33657066 DOI: 10.1097/jcn.0000000000000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about risk factors for poor adjustment to the device after cardiac resynchronization therapy (CRT) implantation in patients with heart failure. PURPOSE The aim of this study was to explore device adjustment and the postoperative recovery of patients with heart failure undergoing elective CRT device implantation. METHODS In this prospective multicenter longitudinal study, data were collected before implantation and after 2 weeks, 6 months, and 1 year, using validated self-reported instruments and investigator-designed, CRT-specific questions. RESULTS A total of 133 patients, 79% male, with a mean age of 70 ± 10 years, were included. Patients adjusted to the device over time (P < .001), but 20% of patients had difficulties after 2 weeks, and 11% had difficulties at the 1-year follow-up. Fatigue was the most common health problem before surgery (87%), which was reduced to 65% after 1 year, P < .001. Patients' recovery improved over time (P < .001). Device-specific problems with hiccups (7% vs 14%), pulsation around the device (29% vs 24%), tachycardia (28% vs 29%), appearance of the scar (21% vs 17%), and the device bulging out (65% vs 61%) remained unchanged over time, whereas stiffness in the shoulder (64% vs 28%, P < .001) and wound healing (9% vs 2%, P < .05) improved. CONCLUSIONS Most patients with heart failure recover and adjust early after their CRT implantation and improve even more during follow-up. However, recovery and adjustment are problematic for some patients, and many experience bodily discomforts because of the device. Early screening for poor adjustment and psychological distress can lead to appropriate interventions and timely referrals. This is important in the era of remote monitoring with less face-to-face contact.
Collapse
|
10
|
Tokodi M, Schwertner WR, Kovács A, Tősér Z, Staub L, Sárkány A, Lakatos BK, Behon A, Boros AM, Perge P, Kutyifa V, Széplaki G, Gellér L, Merkely B, Kosztin A. Machine learning-based mortality prediction of patients undergoing cardiac resynchronization therapy: the SEMMELWEIS-CRT score. Eur Heart J 2020; 41:1747-1756. [PMID: 31923316 PMCID: PMC7205468 DOI: 10.1093/eurheartj/ehz902] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/24/2019] [Accepted: 12/03/2019] [Indexed: 12/20/2022] Open
Abstract
AIMS Our aim was to develop a machine learning (ML)-based risk stratification system to predict 1-, 2-, 3-, 4-, and 5-year all-cause mortality from pre-implant parameters of patients undergoing cardiac resynchronization therapy (CRT). METHODS AND RESULTS Multiple ML models were trained on a retrospective database of 1510 patients undergoing CRT implantation to predict 1- to 5-year all-cause mortality. Thirty-three pre-implant clinical features were selected to train the models. The best performing model [SEMMELWEIS-CRT score (perSonalizEd assessMent of estiMatEd risk of mortaLity With machinE learnIng in patientS undergoing CRT implantation)], along with pre-existing scores (Seattle Heart Failure Model, VALID-CRT, EAARN, ScREEN, and CRT-score), was tested on an independent cohort of 158 patients. There were 805 (53%) deaths in the training cohort and 80 (51%) deaths in the test cohort during the 5-year follow-up period. Among the trained classifiers, random forest demonstrated the best performance. For the prediction of 1-, 2-, 3-, 4-, and 5-year mortality, the areas under the receiver operating characteristic curves of the SEMMELWEIS-CRT score were 0.768 (95% CI: 0.674-0.861; P < 0.001), 0.793 (95% CI: 0.718-0.867; P < 0.001), 0.785 (95% CI: 0.711-0.859; P < 0.001), 0.776 (95% CI: 0.703-0.849; P < 0.001), and 0.803 (95% CI: 0.733-0.872; P < 0.001), respectively. The discriminative ability of our model was superior to other evaluated scores. CONCLUSION The SEMMELWEIS-CRT score (available at semmelweiscrtscore.com) exhibited good discriminative capabilities for the prediction of all-cause death in CRT patients and outperformed the already existing risk scores. By capturing the non-linear association of predictors, the utilization of ML approaches may facilitate optimal candidate selection and prognostication of patients undergoing CRT implantation.
Collapse
Affiliation(s)
- Márton Tokodi
- Heart and Vascular Center, Semmelweis University, 68 Városmajor St., Budapest 1122, Hungary
| | | | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, 68 Városmajor St., Budapest 1122, Hungary
| | - Zoltán Tősér
- Argus Cognitive, Inc., 16 Cavendish Ct., Lebanon, NH 03766, USA
| | - Levente Staub
- Argus Cognitive, Inc., 16 Cavendish Ct., Lebanon, NH 03766, USA
| | - András Sárkány
- Argus Cognitive, Inc., 16 Cavendish Ct., Lebanon, NH 03766, USA
| | - Bálint Károly Lakatos
- Heart and Vascular Center, Semmelweis University, 68 Városmajor St., Budapest 1122, Hungary
| | - Anett Behon
- Heart and Vascular Center, Semmelweis University, 68 Városmajor St., Budapest 1122, Hungary
| | - András Mihály Boros
- Heart and Vascular Center, Semmelweis University, 68 Városmajor St., Budapest 1122, Hungary
| | - Péter Perge
- Heart and Vascular Center, Semmelweis University, 68 Városmajor St., Budapest 1122, Hungary
| | - Valentina Kutyifa
- Heart and Vascular Center, Semmelweis University, 68 Városmajor St., Budapest 1122, Hungary
- Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., Box 653, Rochester, NY 14642, USA
| | - Gábor Széplaki
- Heart and Vascular Center, Semmelweis University, 68 Városmajor St., Budapest 1122, Hungary
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, 68 Városmajor St., Budapest 1122, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 68 Városmajor St., Budapest 1122, Hungary
| | - Annamária Kosztin
- Heart and Vascular Center, Semmelweis University, 68 Városmajor St., Budapest 1122, Hungary
| |
Collapse
|
11
|
Yang S, Liu Z, Li W, Hu Y, Liu S, Jing R, Hua W. Validation of Three European Risk Scores to Predict Long-Term Outcomes for Patients Receiving Cardiac Resynchronization Therapy in an Asian Population. J Cardiovasc Transl Res 2020; 14:754-760. [PMID: 32372168 DOI: 10.1007/s12265-020-09999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/01/2020] [Indexed: 11/26/2022]
Abstract
To validate externally and recalibrate three European risk scores for all-cause mortality and transplantation in patients receiving cardiac resynchronization therapy (CRT) in an Asian population. Data were collected at our institution between January 2010 and December 2017. The primary endpoints were all-cause mortality and heart transplantation. Of the 506 patients who were followed for 2 years, 104 reached the primary endpoint. The Kaplan-Meier event-free survival analysis, stratified according to the three scores, yielded significant results (log-rank test, all P < 0.05), with a good fit between the predicted and observed event rates (Hosmer-Lemeshow goodness-of-fit test, all P > 0.05). The ScREEN score yielded the best discriminatory power for the primary endpoints compared with the VALID-CRT and EAARN scores. ScREEN was the best predictor of all-cause mortality and heart transplantation. Risk scores based on different populations should be selected cautiously. Graphical Abstract.
Collapse
Affiliation(s)
- Shengwen Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100039, China
| | - Zhimin Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100039, China
| | - Wenran Li
- MOE Key Laboratory of Bioinformatics, Bioinformatics Division and Center for Synthetic and Systems Biology, BNRist, Department of Automation, Tsinghua University, Beijing, 100084, China
| | - Yiran Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100039, China
| | - Shangyu Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100039, China
| | - Ran Jing
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100039, China
| | - Wei Hua
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100039, China.
- , Beijing, China.
| |
Collapse
|
12
|
Mertens BJA, Banzato E, de Wreede LC. Construction and assessment of prediction rules for binary outcome in the presence of missing predictor data using multiple imputation and cross-validation: Methodological approach and data-based evaluation. Biom J 2020; 62:724-741. [PMID: 32052492 PMCID: PMC7217034 DOI: 10.1002/bimj.201800289] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/18/2019] [Accepted: 11/04/2019] [Indexed: 12/24/2022]
Abstract
We investigate calibration and assessment of predictive rules when missing values are present in the predictors. Our paper has two key objectives. The first is to investigate how the calibration of the prediction rule can be combined with use of multiple imputation to account for missing predictor observations. The second objective is to propose such methods that can be implemented with current multiple imputation software, while allowing for unbiased predictive assessment through validation on new observations for which outcome is not yet available. We commence with a review of the methodological foundations of multiple imputation as a model estimation approach as opposed to a purely algorithmic description. We specifically contrast application of multiple imputation for parameter (effect) estimation with predictive calibration. Based on this review, two approaches are formulated, of which the second utilizes application of the classical Rubin's rules for parameter estimation, while the first approach averages probabilities from models fitted on single imputations to directly approximate the predictive density for future observations. We present implementations using current software that allow for validation and estimation of performance measures by cross-validation, as well as imputation of missing data in predictors on the future data where outcome is missing by definition. To simplify, we restrict discussion to binary outcome and logistic regression throughout. Method performance is verified through application on two real data sets. Accuracy (Brier score) and variance of predicted probabilities are investigated. Results show substantial reductions in variation of calibrated probabilities when using the first approach.
Collapse
Affiliation(s)
- Bart J A Mertens
- Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Erika Banzato
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Liesbeth C de Wreede
- Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
13
|
Sandhu A, Levy A, Varosy PD, Matlock D. Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy in Older Adults With Heart Failure. J Am Geriatr Soc 2019; 67:2193-2199. [PMID: 31403714 DOI: 10.1111/jgs.16099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/04/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) are cardiac implantable electronic devices that may improve morbidity and mortality in select patients with heart failure. Although the benefits of these devices have been well defined, competing mortality risks, comorbid conditions, and frailty pose difficulty in determining risk-benefit trade-offs when these options are considered for older adults. CONCLUSION In this review, we focus on the benefit, risk, and use of ICD and CRT in older adults, particularly because the goals of care for many older adults include a shift away from life-prolonging interventions. Additionally, we discuss periprocedural risk, cost, and maintenance in older populations. Finally, we introduce a framework for helping clinicians and older adults make these challenging decisions collectively. J Am Geriatr Soc 67:2193-2199, 2019.
Collapse
Affiliation(s)
- Amneet Sandhu
- Section of Electrophysiology, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado.,Section of Electrophysiology, University of Colorado School of Medicine, Aurora, Colorado.,Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Andrew Levy
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Paul D Varosy
- Section of Electrophysiology, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado.,Section of Electrophysiology, University of Colorado School of Medicine, Aurora, Colorado.,Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel Matlock
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.,Veterans Affairs (VA) Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado.,Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, Colorado
| |
Collapse
|
14
|
Bertaglia E, Arena G, Pecora D, Reggiani A, D'Onofrio A, Palmisano P, De Simone A, Caico SI, Marini M, Maglia G, Ferraro A, Solimene F, Cecchetto A, Malacrida M, Botto GL, Lunati M, Stabile G. The VALID-CRT risk score reliably predicts response and outcome of cardiac resynchronization therapy in a real-world population. Clin Cardiol 2019; 42:919-924. [PMID: 31301152 PMCID: PMC6788573 DOI: 10.1002/clc.23229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/24/2019] [Accepted: 06/28/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The aim of the study was to confirm the value of the VALID-cardiac resynchronization therapy (CRT) risk score in predicting outcome and to assess its association with clinical response (CR) in an unselected real-world CRT population. METHODS AND RESULTS The present analysis comprised all consecutive CRT patients (pts) enrolled in the CRT-MORE registry from 2011 to 2013. Pts were stratified into five groups (quintiles 1-5) according to the VALID-CRT risk predictor index applied to the CRT-MORE population. In the analysis of clinical outcome, adverse events comprised death from any cause and non-fatal heart failure (HF) events requiring hospitalization. CR at 12-month follow-up was also assessed. We enrolled 905 pts. During a median follow-up of 1005 [627-1361] days, 134 patients died, and 79 had at least one HF hospitalization. At 12 months, 69% of pts displayed an improvement in their CR. The mean VALID-CRT risk score derived from the CRT-MOdular Registry (MORE) population was 0.317, ranging from -0.419 in Q1 to 2.59 in Q5. The risk-stratification algorithm was able to predict total mortality after CRT (survival ranging from 93%-Q1 to 77%-Q5; hazards ratio [HR] = 1.42, 95% confidence interval [CI]: 1.25-1.61, P < .0001), and HF hospitalization (ranging from 95% to 90%; HR = 1.24, 95% CI: 1.06-1.45, P = .009). CR was significantly lower in pts with a high-to-very high risk profile (Q4-5) than in pts with a low-to-intermediate risk profile (Q1-2-3) (55% vs 79%, P < .0001). CONCLUSION The VALID-CRT risk-stratification algorithm reliably predicts outcome and CRT response after CRT in an unselected, real-world population.
Collapse
Affiliation(s)
- Emanuele Bertaglia
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padua, Italy
| | | | | | | | | | - Pietro Palmisano
- Cardiology Unit, 'Card. G. Panico' Hospital, Tricase (LE), Italy
| | | | | | | | | | | | | | | | | | - Giovanni L Botto
- U.O. Electrophysiology, ASST Rhodense, Rho-Garbagnate Milanese (MI), Italy
| | - Maurizio Lunati
- Cardiotoracovascular Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | |
Collapse
|
15
|
Zweerink A, Friedman DJ, Klem I, van de Ven PM, Vink C, Biesbroek PS, Hansen SM, Emerek K, Kim RJ, van Rossum AC, Atwater BD, Nijveldt R, Allaart CP. Size Matters. Circ Arrhythm Electrophysiol 2018; 11:e006767. [DOI: 10.1161/circep.118.006767] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alwin Zweerink
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands (ACS) (A.Z., C.V., S.B., A.C.v.R., R.N., C.P.A.)
| | - Daniel J. Friedman
- Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., I.K., S.M.H., K.E., R.J.K., B.D.A.)
| | - Igor Klem
- Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., I.K., S.M.H., K.E., R.J.K., B.D.A.)
| | - Peter M. van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands (P.M.v.d.V.)
| | - Caitlin Vink
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands (ACS) (A.Z., C.V., S.B., A.C.v.R., R.N., C.P.A.)
| | - P. Stefan Biesbroek
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands (ACS) (A.Z., C.V., S.B., A.C.v.R., R.N., C.P.A.)
| | - Steen M. Hansen
- Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., I.K., S.M.H., K.E., R.J.K., B.D.A.)
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark (S.M.H.)
| | - Kasper Emerek
- Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., I.K., S.M.H., K.E., R.J.K., B.D.A.)
- Department of Clinical Medicine, Aalborg University Hospital, Denmark (K.E.)
| | - Raymond J. Kim
- Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., I.K., S.M.H., K.E., R.J.K., B.D.A.)
| | - Albert C. van Rossum
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands (ACS) (A.Z., C.V., S.B., A.C.v.R., R.N., C.P.A.)
| | - Brett D. Atwater
- Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., I.K., S.M.H., K.E., R.J.K., B.D.A.)
| | - Robin Nijveldt
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands (ACS) (A.Z., C.V., S.B., A.C.v.R., R.N., C.P.A.)
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (R.N.)
| | - Cornelis P. Allaart
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands (ACS) (A.Z., C.V., S.B., A.C.v.R., R.N., C.P.A.)
| |
Collapse
|
16
|
Optimization of coronary sinus lead placement targeted to right-to-left delay in patients undergoing cardiac resynchronization therapy. Europace 2018; 21:502-510. [DOI: 10.1093/europace/euy275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 10/18/2018] [Indexed: 11/14/2022] Open
|