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Performance of Prognostic Heart Failure Models in Patients With Nonischemic Cardiomyopathy Undergoing
Daniele Muser1, Jackson J Liang1, Simon A Castro1
1Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
The Seattle Heart Failure Model (SHFM) and PAINESD scores accurately predict outcomes in nonischemic dilated cardiomyopathy patients with ventricular tachycardia undergoing catheter ablation. These models offer superior risk stratification for death, transplant, and VT recurrence.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Research
Background:
- Accurate pre-procedural risk stratification is essential for patients with nonischemic dilated cardiomyopathy (NIDCM) and ventricular tachycardia (VT) undergoing catheter ablation (CA).
- The comparative performance of existing risk stratification models for predicting outcomes after CA in this specific patient population remains largely unknown.
Purpose of the Study:
- To evaluate and compare the performance of eight established prognostic scores in predicting adverse outcomes following CA for VT in patients with NIDCM.
- To identify the most accurate risk models for guiding clinical decision-making and patient management.
Main Methods:
- A cohort of 282 consecutive patients with NIDCM undergoing CA for VT was analyzed.
- Eight prognostic scores, including SHFM and PAINESD, were assessed for their ability to predict death/cardiac transplantation and VT recurrence.
- Model performance was evaluated using discrimination (Area Under the Curve - AUC) and calibration (goodness-of-fit tests).
Main Results:
- After a median follow-up of 48 months, 15% of patients died, 9% underwent transplantation, and 21% experienced VT recurrence.
- The Seattle Heart Failure Model (SHFM) demonstrated superior prognostic accuracy for both death/transplant (AUC=0.89) and VT recurrence (AUC=0.77).
- The PAINESD score also showed strong performance (AUC=0.83 for death/transplant, AUC=0.68 for VT recurrence), outperforming other evaluated scores.
Conclusions:
- The SHFM and PAINESD risk scores are highly effective predictors of adverse outcomes, including death, transplantation, and VT recurrence, in NIDCM patients undergoing CA.
- These models offer significantly better predictive performance compared to other commonly used risk scores.
- Pre-procedural calculation of SHFM and PAINESD scores can aid in predicting patient outcomes and informing treatment strategies.
Objectives:
This study sought to assess the performance of established risk models in predicting outcomes after catheter ablation (CA) in patients with nonischemic dilated cardiomyopathy (NIDCM) and ventricular tachycardia (VT).
Background:
A correct pre-procedural risk stratification of patients with NIDCM and VT undergoing CA is crucial. The performance of different pre-procedural risk stratification approaches to predict outcomes of CA of VT in patients with NIDCM is unknown.
Methods:
The study compared the performance of 8 prognostic scores (SHFM [Seattle Heart Failure Model], MAGGIC [Meta-analysis Global Group in Chronic Heart Failure], ADHERE [Acute Decompensated Heart Failure National Registry], EFFECT [Enhanced Feedback for Effective Cardiac Treatment-Heart Failure], OPTIMIZE-HF [Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure], CHARM [Candesartan in Heart Failure-Assessment of Reduction in Mortality], EuroSCORE [European System for Cardiac Operative Risk Evaluation], and PAINESD [Chronic Obstructive Pulmonary Disease, Age > 60 Years, Ischemic Cardiomyopathy, New York Heart Association Functional Class III or IV, Ejection Fraction <25%, Presentation With VT Storm, Diabetes Mellitus]) for the endpoints of death/cardiac transplantation and VT recurrence in 282 consecutive patients (age 59 ± 15 years, left ventricular ejection fraction: 36 ± 13%) with NIDCM undergoing CA of VT. Discrimination and calibration of each model were evaluated through area under the curve (AUC) of receiver-operating characteristic curve and goodness-of-fit test.
Results:
After a median follow-up of 48 (interquartile range: 19-67) months, 43 patients (15%) died, 24 (9%) underwent heart transplantation, and 58 (21%) experienced VT recurrence. The prognostic accuracy of SHFM (AUC = 0.89; goodness-of-fit p = 0.68 for death/transplant and AUC = 0.77; goodness-of-fit p = 0.16 for VT recurrence) and PAINESD (AUC = 0.83; goodness-of-fit p = 0.24 for death/transplant and AUC = 0.68; goodness-of-fit p = 0.58 for VT recurrence) were significantly superior to that of other scores.
Conclusions:
In patients with NIDCM and VT undergoing CA, the SHFM and PAINESD risk scores are powerful predictors of recurrent VT and death/transplant during follow-up, with similar performance and significantly superior to other scores. A pre-procedural calculation of the SHFM and PAINESD can be useful to predict outcomes.
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