title: Combined score using clinical, electrocardiographic, and echocardiographic parameters to predict left ventricular remodeling in patients having had cardiac resynchronization therapy six months earlier.
abstract: The aim of this study was to evaluate whether a scoring system integrating clinical, electrocardiographic, and echocardiographic measurements can predict left ventricular reverse remodeling after cardiac resynchronization therapy (CRT). The derivation cohort consisted of 162 patients with heart failure implanted with a CRT device. Baseline clinical, electrocardiographic, and echocardiographic characteristics were entered into univariate and multivariate models to predict reverse remodeling as defined by a ≥15% reduction in left ventricular end-systolic volume at 6 months (60%). Combinations of predictors were then tested under different scoring systems. A new 7-point CRT response score termed L2ANDS2: Left bundle branch block (2 points), Age >70 years, Nonischemic origin, left ventricular end-diastolic Diameter <40 mm/m(2), and Septal flash (2 points) was calculated for these patients. This score was then validated against a validation cohort of 45 patients from another academic center. A highly significant incremental predictive value was noted when septal flash was added to an initial 4-factor model including left bundle branch block (difference between area under the curve C statistics = 0.125, p <0.001). The predictive accuracy using the L2ANDS2 score was then 0.79 for the C statistic. Application of the new score to the validation cohort (71% of responders) gave a similar C statistic (0.75). A score >5 had a high positive likelihood ratio (+LR = 5.64), whereas a score <2 had a high negative likelihood ratio (-LR = 0.19). In conclusion, this L2ANDS2 score provides an easy-to-use tool for the clinician to assess the pretest probability of a patient being a CRT responder.
authors.affiliation: CIC-IT U 804, Centre Hospitalier Universitaire Rennes, Université Rennes 1, France; INSERM, U1099, Rennes, France; Université Rennes 1, LTSI, Rennes, France; Université François Rabelais, Tours, France; Service de Cardiologie, Centre Hospitalier Universitaire Tours, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Brunet-Bernard
authors.affiliation: Université Lille Nord de France, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté Libre de Médecine, Université Catholique de Lille, Lille, France; INSERM, U1088, Université de Picardie, Amiens, France.
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Maréchaux
authors.affiliation: Université François Rabelais, Tours, France; Service de Cardiologie, Centre Hospitalier Universitaire Tours, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
authors.affiliation: Université Lille Nord de France, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté Libre de Médecine, Université Catholique de Lille, Lille, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Guiot
authors.affiliation: CIC-IT U 804, Centre Hospitalier Universitaire Rennes, Université Rennes 1, France; Université Rennes 1, LTSI, Rennes, France; Service de Cardiologie, Centre Hospitalier Universitaire Rennes, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Fournet
authors.affiliation: CIC-IT U 804, Centre Hospitalier Universitaire Rennes, Université Rennes 1, France; INSERM, U1099, Rennes, France; Université Rennes 1, LTSI, Rennes, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Reynaud
authors.affiliation: CIC-IT U 804, Centre Hospitalier Universitaire Rennes, Université Rennes 1, France; INSERM, U1099, Rennes, France; Université Rennes 1, LTSI, Rennes, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Schnell
authors.affiliation: CIC-IT U 804, Centre Hospitalier Universitaire Rennes, Université Rennes 1, France; Université Rennes 1, LTSI, Rennes, France; Service de Cardiologie, Centre Hospitalier Universitaire Rennes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Leclercq
authors.affiliation: CIC-IT U 804, Centre Hospitalier Universitaire Rennes, Université Rennes 1, France; Université Rennes 1, LTSI, Rennes, France; Service de Cardiologie, Centre Hospitalier Universitaire Rennes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mabo
authors.affiliation: CIC-IT U 804, Centre Hospitalier Universitaire Rennes, Université Rennes 1, France; Université Rennes 1, LTSI, Rennes, France; Service de Cardiologie, Centre Hospitalier Universitaire Rennes, France. Electronic address: erwan.donal@chu-rennes.fr.
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D015150:Echocardiography, Doppler / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology*