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Published on: January 14, 2014
Development of a risk score for patients with ischaemic cardiomyopathy
Eduard Ródenas-Alesina1, Guillermo Romero-Farina2, Lorena Herrador1
1Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain.
Insights
A new risk score accurately predicts major adverse cardiovascular events (MACE) in patients with ischaemic cardiomyopathy. This score uses clinical data and gated single-photon emission computed tomography (SPECT) to identify high-risk individuals needing closer monitoring.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Cardiovascular Imaging
Background:
- Ischaemic cardiomyopathy is a primary cause of heart failure with significant mortality.
- Effective risk stratification is crucial for managing patients with this condition.
Purpose of the Study:
- To identify predictors of major adverse cardiovascular events (MACE) in ischaemic cardiomyopathy.
- To develop and validate a risk score for predicting MACE.
Main Methods:
- Retrospective analysis of 747 patients with ischaemic cardiomyopathy undergoing gated single-photon emission computed tomography (SPECT).
- Clinical and SPECT-derived variables were analyzed for MACE prediction using Cox regression.
- A risk score was developed and internally validated.
Main Results:
- Major adverse cardiovascular events (MACE) occurred in 41.9% of patients over a median follow-up of 4.7 years.
- Key predictors included prior heart failure, worsening symptoms, reduced kidney function, older age, diabetes, atrial fibrillation, enlarged heart chambers, and myocardial scar burden.
- The developed risk score effectively stratified patients into intermediate, high, and very high-risk categories with distinct event rates.
Conclusions:
- A straightforward risk score, utilizing readily available clinical and gated SPECT data, accurately predicts MACE risk in ischaemic cardiomyopathy.
- This tool aids in identifying patients who may benefit from intensified management strategies.
Background:
Ischaemic cardiomyopathy is a leading cause of heart failure and is associated with a poor prognosis.
Aim:
To evaluate predictors of major adverse cardiovascular events (MACE) and to develop a risk score for the disease.
Methods:
All patients with ischaemic cardiomyopathy referred to a tertiary hospital between 2010 and 2018 for stress-rest gated single-photon emission computed tomography (SPECT) were included retrospectively (n=747). Clinical and gated SPECT-derived variables were analysed as predictors of MACE, a combined endpoint of cardiovascular mortality, heart failure hospitalization or myocardial infarction during follow-up. A multivariable Cox model using backwards stepwise regression with competing risks was used to select the best parsimonious model.
Results:
After a median follow-up of 4.7 years, 313 patients had MACE (41.9%). Independent predictors of MACE were previous heart failure admission, worsening angina or dyspnoea, estimated glomerular filtration rate ≤60mL/min/1.73 m2, age>73 years, diabetes, atrial fibrillation, end-diastolic volume index>83mL/m2 and>12% of scarred myocardium. A risk score ranging from 0 to 12 classified patients as at intermediate risk (event rate of 4.0 MACE per 100 person-years), high risk (11.3 MACE per 100 person-years) or very high risk (27.8 MACE per 100 person-years). The internally validated area under the curve was 0.720 (95% confidence interval 0.660-0.740) and calibration was adequate (Hosmer-Lemeshow test P=0.28) for MACE.
Conclusions:
In patients with ischaemic cardiomyopathy, a simple risk score using dichotomic and readily available variables obtained from clinical assessment and gated SPECT accurately predicts the risk of MACE.
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