Usefulness of a clinical risk score to predict the response to cardiac resynchronization therapy
Rui Providencia1, Eloi Marijon2, Sergio Barra3
1St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Nouvelles Cliniques Nantaises, Nantes, France; Farr Institute of Health Informatics Research, University College of London, London, United Kingdom.
Insights
A new ScREEN score predicts which heart failure patients will not respond to cardiac resynchronization therapy (CRT). This score helps optimize patient management and consider alternative treatments early.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Prediction Models
Background:
- Approximately one-third of patients with heart failure do not benefit from cardiac resynchronization therapy (CRT).
- Identifying non-responders early is crucial for optimizing patient management and treatment strategies.
Purpose of the Study:
- To develop and validate a simple clinical score to predict response to CRT.
- To assess the score's association with CRT response, all-cause mortality, and heart transplantation.
Main Methods:
- A risk score (ScREEN) was derived from factors associated with CRT response in a multi-center French cohort of 1301 patients.
- The score was externally validated in 1959 patients across four high-volume European centers.
- Predictors included sex, NYHA class, ejection fraction, QRS duration, and estimated glomerular filtration rate.
Main Results:
- The ScREEN score demonstrated good calibration, accuracy, and discrimination in external validation.
- CRT response rates increased progressively with higher scores, from 37.5% to 91.9%.
- Similar predictive performance was observed for all-cause mortality or heart transplantation.
Conclusions:
- The ScREEN score, utilizing readily available clinical factors, effectively predicts CRT response and overall mortality.
- This score can aid clinicians in identifying patients unlikely to benefit from CRT, facilitating timely consideration of alternative therapies.
Background:
Almost 1/3 of heart failure patients fail to respond to cardiac resynchronization therapy (CRT). A simple clinical score to predict who these patients are at the moment of referral or at time of implant may be of importance for early optimization of their management.
Methods:
Observational study. A risk score was derived from factors associated to CRT response. The derivation cohort was composed of 1301 patients implanted with a CRT defibrillator in a multi-center French cohort-study. External validation of this score and assessment of its association with CRT response and all-cause mortality and/or heart transplant was performed in 1959 CRT patients implanted in 4 high-volume European centers.
Results:
Independent predictors of CRT response in the derivation cohort were: female gender (OR = 2.08, 95% CI 1.26-3.45), NYHA class ≤ III (OR = 2.71, 95% CI 1.63-4.52), left ventricular ejection fraction ≥ 25% (OR = 1.75, 95% CI 1.27-2.41), QRS duration ≥ 150 ms (OR = 1.70, 95% CI 1.25-2.30) and estimated glomerular filtration rate ≥ 60 mL/min (OR = 2.01, 95% CI 1.48-2.72). Each was assigned 1 point. External validation showed good calibration (Hosmer-Lemeshow test-P = 0.95), accuracy (Brier score = 0.19) and discrimination (c-statistic = 0.67), with CRT response increasing progressively from 37.5% in patients with a score of 0 to 91.9% among those with score of 5 (Gamma for trend = 0.44, P < 0.001). Similar results were observed regarding all-cause mortality or heart transplant.
Conclusion:
The ScREEN score (Sex category, Renal function, ECG/QRS width, Ejection fraction and NYHA class) is composed of widely validated, easy to obtain predictors of CRT response, and predicts CRT response and overall mortality. It should be helpful in facilitating early consideration of alternative therapies for predicted non-responders to CRT therapy.
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