Novel risk scoring system with preoperative objective parameters gives a good prediction of 1-year mortality in patients with a left ventricular assist device.
BACKGROUND
As we have previously reported, the preoperative profile defined by INTERMACS is a good predictor for the prognosis after left ventricular assist device (LVAD) implantation, but is largely dependent on the physician's decision. Several other risk stratification systems including objective parameters (eg, Leitz-Miller, Columbia, Seattle Heart Failure Model, APACHE II) have been proposed to estimate patient's mortality after LVAD implantation.


RESULTS
According to the preoperative data from 59 patients who received LVAD (10 implantable, 49 extracorporeal) since 2002 through 2010, we performed a logistic analysis and constructed a new scoring system (ie, the TODAI VAD score (TVAD score), assigning 8 points to serum albumin <3.2mg/dl (odds ratio [OR] 8.475), 7 points to serum total bilirubin >4.8mg/dl (OR 7.300), 6 points to left ventricular end-diastolic diameter <55mm (OR 5.917), 5 points to central venous pressure >11mmHg (OR 5.128)). The receiver-operating characteristic analysis showed that the area under the curve of our new scoring system (0.864) was significantly larger than any of the abovementioned 5 scoring methods (all P<0.05). With the TVAD score, low (0-8 points), intermediate (9-17 points), and high (18-26 points) risk strata had significantly different 1-year survival rates of 95%, 54%, and 14%, respectively (all P<0.001).


CONCLUSIONS
The TVAD score can predict the prognosis after LVAD implantation much better than the previously known methods.
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Teruhiko
T
Imamura
Koichiro
K
Kinugawa
Taro
T
Shiga
Miyoko
M
Endo
Naoko
N
Kato
Toshiro
T
Inaba
Hisataka
H
Maki
Masaru
M
Hatano
Atsushi
A
Yao
Takashi
T
Nishimura
Yasunobu
Y
Hirata
Shunei
S
Kyo
Minoru
M
Ono
Ryozo
R
Nagai
D000328:Adult; D001663:Bilirubin / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000401:mortality / Q000628:therapy; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012709:Serum Albumin / Q000378:metabolism*; D015996:Survival Rate
D012709:Serum Albumin; D001663:Bilirubin