Effectiveness of adding a defibrillator with cardiac resynchronization therapy in heart failure according to the
Sijing Cheng1, Yu Deng1, Hao Huang1
1The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Beijing 100037, China.
Insights
The MELD-Albumin score can help identify heart failure patients who may not benefit from cardiac resynchronization therapy with a defibrillator (CRT-D). Higher scores indicate an increased risk of mortality or worsening heart failure with CRT-D.
Area of Science:
- Cardiology
- Medical Devices
- Health Outcomes Research
Background:
- Current guidelines lack clear recommendations for choosing between cardiac resynchronization therapy with a defibrillator (CRT-D) and cardiac resynchronization therapy with a pacemaker (CRT-P).
- Identifying patients who may not benefit from CRT-D is crucial for optimizing treatment strategies.
Purpose of the Study:
- To investigate whether the MELD-Albumin score can predict outcomes in patients receiving CRT-D versus CRT-P.
- To determine if the MELD-Albumin score can help select patients who may not benefit from CRT-D.
Main Methods:
- A cohort study included 752 patients who received CRT-P or CRT-D between 2010 and 2022.
- The primary endpoint was a composite of all-cause mortality or worsening heart failure.
- Multivariable-adjusted Cox proportional hazard regression was used to analyze the association between the MELD-Albumin score and outcomes, assessing interactions with CRT-D.
Main Results:
- The MELD-Albumin score was significantly associated with the primary endpoint in the CRT-D group (HR 1.16) but not in the CRT-P group (HR 1.03).
- A significant interaction was found between the MELD-Albumin score and the effect of CRT-D (P=0.013).
- For patients with a MELD-Albumin score ≥ 12, CRT-D was associated with a higher risk of the primary endpoint (HR 1.99), unlike those with a score < 12 (HR 1.19).
Conclusions:
- The MELD-Albumin score is a valuable tool for predicting outcomes in heart failure patients undergoing cardiac resynchronization therapy.
- CRT-D may be associated with an increased risk of adverse clinical endpoints in heart failure patients with a MELD-Albumin score of 12 or higher.
Abstract:
Current guidelines lack clear recommendations between the implantation of cardiac resynchronization therapy (CRT) with defibrillator (CRT-D) and CRT with pacemaker (CRT-P). We hypothesized that modified model for end-stage liver disease score including albumin (MELD-Albumin score), could be used to select patients who may not benefit from CRT-D. We consecutively included patients with CRT-P or CRT-D implantation between 2010 and 2022. The primary endpoint was the composite of all-cause mortality or worsening heart failure. We performed multivariable-adjusted Cox proportional hazard regression. We assessed the interaction between the MELD-Albumin score and the effect of adding a defibrillator with CRT.A total of 752 patients were included in this study, with 291 implanted CRT-P. During a median follow-up of 880 days, 205 patients reached the primary endpoint. MELD-Albumin score was significantly associated with the primary endpoint in the CRT-D group [HR 1.16 (1.09-1.24); P < 0.001] but not in the CRT-P group [HR 1.03 (0.95-1.12); P = 0.49]. There was a significant interaction between the MELD-Albumin score and the effect of CRTD (P = 0.013). The optimal cut-off value of the MELD-Albumin score was 12. For patients with MELD-Albumin ≥ 12, CRT-D was associated with a higher occurrence of the primary endpoint [HR 1.99 (1.10-3.58); P = 0.02], whereas not in patients with MELD-Albumin < 12 [HR 1.19 (0.83-1.70); P = 0.35). Our findings suggest that CRT-D is associated with an excess risk of composite clinical endpoints in HF patients with higher MELD-Albumin score.
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