Development and Validation of Predictive Models of Cardiac Mortality and Transplantation in Resynchronization Therapy

Eduardo Arrais Rocha, Francisca Tatiana Moreira Pereira, José Sebastião Abreu, José Wellington O. Lima, Marcelo de Paula Martins Monteiro, Almino Cavalcante Rocha, Camilla Viana Arrais Goés, Ana Gardênia P. Farias, Carlos Roberto Martins Rodrigues, Ana Rosa Pinto Quidute, Maurício Ibrahim Scanavacca

AbstractBackground:30-40% of cardiac resynchronization therapy cases do not achieve favorable outcomes. This study aimed to develop predictive models for the combined endpoint of cardiac death and transplantation (Tx) at different stages of cardiac resynchronization therapy (CRT). Prospective observational study of 116 patients aged 64.8 ± 11.1 years, 68.1% of whom had functional class (FC) III and 31.9% had ambulatory class IV. Clinical, electrocardiographic and echocardiographic variables were assessed by using Cox regression and Kaplan-Meier curves. The cardiac mortality/Tx rate was 16.3% during the follow-up period of 34.0 ± 17.9 months. Prior to implantation, right ventricular dysfunction (RVD), ejection fraction < 25% and use of high doses of diuretics (HDD) increased the risk of cardiac death and Tx by 3.9-, 4.8-, and 5.9-fold, respectively. In the first year after CRT, RVD, HDD and hospitalization due to congestive heart failure increased the risk of death at hazard ratios of 3.5, 5.3, and 12.5, respectively. In the second year after CRT, RVD and FC III/IV were significant risk factors of mortality in the multivariate Cox model. The accuracy rates of the models were 84.6% at preimplantation, 93% in the first year after CRT, and 90.5% in the second year after CRT. The models were validated by bootstrapping. We developed predictive models of cardiac death and Tx at different stages of CRT based on the analysis of simple and easily obtainable clinical and echocardiographic variables. The models showed good accuracy and adjustment, were validated internally, and are useful in the selection, monitoring and counseling of patients indicated for CRT.