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 HeartFailure Model], MAGGIC [Meta-analysis Global Group in Chronic HeartFailure], ADHERE [Acute Decompensated HeartFailure National Registry], EFFECT [Enhanced Feedback for Effective Cardiac Treatment-Heart Failure], OPTIMIZE-HF [Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with HeartFailure], 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. Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Performance of Prognostic HeartFailure Models in Patients With Nonischemic Cardiomyopathy Undergoing VentricularTachycardia Ablation
Muser D;
2019-01-01
Abstract
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 HeartFailure Model], MAGGIC [Meta-analysis Global Group in Chronic HeartFailure], ADHERE [Acute Decompensated HeartFailure National Registry], EFFECT [Enhanced Feedback for Effective Cardiac Treatment-Heart Failure], OPTIMIZE-HF [Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with HeartFailure], 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. Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
