title: Predictors of mortality, LVAD implant, or heart transplant in primary prevention cardiac resynchronization therapy recipients: The HF-CRT score.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) reduces morbidity and mortality among individuals with dyssynchronous systolic heart failure (HF). However, patient outcomes vary, with some at higher risk than others for HF progression and death.
  
  
  OBJECTIVE
  To develop a risk prediction score incorporating variables associated with mortality, left ventricular assist device (LVAD) implant, or heart transplant in recipients of a primary prevention cardiac resynchronization therapy-defibrillator (CRT-D).
  
  
  METHODS
  We followed 305 CRT-D patients from the Prospective Observational Study of Implantable Cardioverter-Defibrillators for the composite outcome of all-cause mortality, LVAD implant, or heart transplant soon after device implantation. Serum biomarkers and electrocardiographic and clinical variables were collected at implant. Multivariable analysis using the Cox proportional hazards model with stepwise selection method was used to fit the final model.
  
  
  RESULTS
  Among 305 patients, 53 experienced the composite endpoint. In multivariable analysis, 5 independent predictors ("HF-CRT") were identified: high-sensitivity C-reactive protein >9.42 ng/L (HR = 2.5 [1.4, 4.5]), New York Heart Association functional class III/IV (HR = 2.3 [1.2, 4.5]), creatinine >1.2 mg/dL (HR = 2.7 [1.4, 5.1]), red blood cell count <4.3 × 10(6)/μL (HR = 2.4 [1.3, 4.7]), and cardiac troponin T >28 ng/L (HR = 2.7 [1.4, 5.2]). One point was attributed to each predictor and 3 score categories were identified. Patients with scores 0-1, 2-3, and 4-5 had a 3-year cumulative event-free survival of 96.8%, 79.7%, and 35.2%, respectively (log-rank, P < .001).
  
  
  CONCLUSIONS
  A simple score combining clinical and readily available biomarker data can risk-stratify CRT patients for HF progression and death. These findings may help identify patients who are in need of closer monitoring or early application of more aggressive circulatory support.
authors.affiliation: Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Maryland.
authors.forename: Victor
authors.initials: V
authors.lastname: Nauffal
authors.affiliation: Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Maryland.
authors.forename: Tanyanan
authors.initials: T
authors.lastname: Tanawuttiwat
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Yiyi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Maryland.
authors.forename: John
authors.initials: J
authors.lastname: Rickard
authors.affiliation: Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Maryland.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Marine
authors.affiliation: Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Maryland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Butcher
authors.affiliation: Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Maryland.
authors.forename: Sanaz
authors.initials: S
authors.lastname: Norgard
authors.affiliation: Department of Medicine, University of Maryland, Baltimore, Maryland.
authors.forename: Timm
authors.initials: T
authors.lastname: Dickfeld
authors.affiliation: Department of Medicine Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Ellenbogen
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.affiliation: Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Maryland.
authors.forename: Gordon F
authors.initials: GF
authors.lastname: Tomaselli
authors.affiliation: Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Maryland. Electronic address: alcheng@jhmi.edu.
authors.forename: Alan
authors.initials: A
authors.lastname: Cheng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D058406:Cardiac Resynchronization Therapy; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D005260:Female; D054143:Heart Failure, Systolic / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention; D016896:Treatment Outcome
keywords: Cardiac resynchronization therapy; Heart failure; Heart transplant; Left ventricular assist device; Mortality