Abstract 12605: Derivation and External Validation of a Cardiac Resynchronization Therapy Response Score
Introduction: In the last decade cardiac resynchronization therapy (CRT) has emerged as one of the most important advances in the treatment of patients with advanced heart failure. Unfortunately, almost tone third of patients do not have any benefit from this therapy. We aimed to derive and validate a CRT response score to improve the selection of patients for this intervention.
Methods: The derivation cohort was composed of patients implanted with a CRT plus defibrillator in a multi-centric French registry. Clinical independent predictors of a favourable response to CRT (either clinical or echocardiographic) were assessed. A risk score was created based on the relative odds ratio of each of the variables. Three categories for predicting CRT response were defined: low (0 to 1), medium (2 to 3) and high (4 to 5) probability of response to CRT therapy. Endpoints assessed as true surrogates of lack of response to CRT-therapy were: all-cause mortality and all-cause mortality or heart transplant.
Results: Among the 1,011 patients implanted with a de novo CRT-D, 75.8% were responders. Independent and significant predictors of CRT response in the first 6 months on multivariate logistic regression were: female gender (OR=2.08), New York Heart Association class ≤III (OR=2.71), left ventricle ejection fraction ≥ 25% (OR=1.75), QRS duration ≥ 150ms (OR=1.70) and estimated glomerular filtration rate > 60ml/min (OR=2.01). All predictors were assigned 1 point. Likelihood of survival during 7,216 patient years in the derivation cohort was 52.9% in the low response, 75.2% in the intermediate and 90.7% in the high response group (log rank P <0.001). External validation found similar results.
Conclusion: We derived a clinical risk score, which appears to identify three different categories of patients with different likelihood of response to CRT therapy. This score may be of interest for prognostic assessment and treatment decisions, namely early referral for heart transplant.
Author Disclosures: E. Marijon: None. R. Providência: None. K. Narayanan: None. S. Barra: None. S. Sporton: None. P. Defaye: None. N. Sadoul: None. O. Piot: None. V. Algalarrondo: None. D. Klug: None. D. Gras: None. L. Fauchier: None. P. Bordachar: None. D. Babuty: None. J. Deharo: None. A. Chow: None. C. Leclercq: None. P. Lambiase: None. S. Boveda: None.
- © 2015 by American Heart Association, Inc.