title: A patient selection score for cardiac resynchronization therapy.
abstract: BACKGROUND
  We hypothesized a patient selection score (PSS) may improve patient selection for cardiac resynchronization therapy (CRT).
  
  
  METHODS
  Of 136 patients who received CRT, group A included 100 study patients and group B 36 patients for validation. A positive response to CRT was a left ventricular (LV) end-systolic volume decrease of ≥15% and survival from heart failure at end of follow-up.
  
  
  RESULTS
  Of 100 group A patients, 37 (37%) were CRT responders during 14-month follow-up. A 7-point PSS was generated based on six variables. The cutoff point for PSS to predict a positive response to CRT was >4 by receiver operating characteristic (ROC) analysis. The area under the ROC curve (AUC) for PSS to predict CRT response was 0.94 (P = 0.0001). CRT responders in patients with a PSS > 4 and ≤4 were 33/40 (83%), and 4/60 (7%), respectively (P < 0.001). Multivariate Cox proportional regression analysis showed that PSS was related to CRT response (hazard ratio = 10.3, P < 0.0001). The CRT response rate in patients with a PSS > 4 in Group B was also significantly higher compared to a PSS ≤ 4 (88% vs. 16%, P < 0.001). The AUC for PSS to predict a CRT response in Group B was 0.91 (P = 0.0001).
  
  
  CONCLUSIONS
  Patients with a PSS >4 are the most likely to respond to CRT. Using this score system, a PSS score >4 can predict the probability of a CRT response up to 88% in patients with heart failure and a wide QRS duration.
authors.affiliation: Cardiac Center of Creighton University School of Medicine, Valhalla, New York, USA.
authors.forename: Xuedong
authors.initials: X
authors.lastname: Shen
authors.forename: Chandra K
authors.initials: CK
authors.lastname: Nair
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.forename: Tom
authors.initials: T
authors.lastname: Hee
authors.forename: Suman
authors.initials: S
authors.lastname: Pasupuleti
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Holmberg
authors.forename: Fenwei
authors.initials: F
authors.lastname: Wang
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Esterbrooks
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D009518:New York / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000379:methods*; D018579:Patient Selection; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014463:Ultrasonography / Q000706:statistics & numerical data*