title: Prognostic Estimation of Advanced Heart Failure With Low Left Ventricular Ejection Fraction and Wide QRS Interval.
abstract: OBJECTIVE
  Cardiac resynchronization therapy (CRT) has been known to improve the outcome of advanced heart failure (HF) but is still underutilized in clinical practice. We investigated the prognosis of patients with advanced HF who were suitable for CRT but were treated with conventional strategies. We also developed a risk model to predict mortality to improve the facilitation of CRT.
  
  
  METHODS
  Patients with symptomatic HF with left ventricular ejection fraction ≤35% and QRS interval >120 ms were consecutively enrolled at cardiovascular hospital. After excluding those patients who had received device therapy, 239 patients (160 males, mean 67±11 years) were eventually recruited.
  
  
  RESULTS
  During a follow-up of 308±236 days, 56 (23%) patients died. Prior stroke, heart rate >90 bpm, serum Na ≤135 mEq/L, and serum creatinine ≥1.5 mg/dL were identified as independent factors using Cox proportional hazards regression. Based on the risk model, points were assigned to each of the risk factors proportional to the regression coefficient, and patients were stratified into three risk groups: low- (0), intermediate-(1-5), and high-risk (>5 points). The 2-year mortality rates of each risk group were 5, 31, and 64 percent, respectively. The C statistic of the risk model was 0.78, and the model was validated in a cohort from a different institution where the C statistic was 0.80.
  
  
  CONCLUSIONS
  The mortality of patients with advanced HF who were managed conventionally was effectively stratified using a risk model. It may be useful for clinicians to be more proactive about adopting CRT to improve patient prognosis.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Changmyung
authors.initials: C
authors.lastname: Oh
authors.forename: Hyuk-Jae
authors.initials: HJ
authors.lastname: Chang
authors.forename: Ji Min
authors.initials: JM
authors.lastname: Sung
authors.forename: Ji Ye
authors.initials: JY
authors.lastname: Kim
authors.forename: Wooin
authors.initials: W
authors.lastname: Yang
authors.forename: Jiyoung
authors.initials: J
authors.lastname: Shim
authors.forename: Seok-Min
authors.initials: SM
authors.lastname: Kang
authors.forename: Jongwon
authors.initials: J
authors.lastname: Ha
authors.forename: Se-Joong
authors.initials: SJ
authors.lastname: Rim
authors.forename: Namsik
authors.initials: N
authors.lastname: Chung