Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Unit of Biostatistics, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy.
JACC Clin Electrophysiol. 2019 Jul;5(7):801-813. doi: 10.1016/j.jacep.2019.04.001. Epub 2019 May 8.
This study sought to assess the performance of established risk models in predicting outcomes after catheter ablation (CA) in patients with nonischemic dilated cardiomyopathy (NIDCM) and ventricular tachycardia (VT).
A correct pre-procedural risk stratification of patients with NIDCM and VT undergoing CA is crucial. The performance of different pre-procedural risk stratification approaches to predict outcomes of CA of VT in patients with NIDCM is unknown.
The study compared the performance of 8 prognostic scores (SHFM [Seattle Heart Failure Model], MAGGIC [Meta-analysis Global Group in Chronic Heart Failure], ADHERE [Acute Decompensated Heart Failure National Registry], EFFECT [Enhanced Feedback for Effective Cardiac Treatment-Heart Failure], OPTIMIZE-HF [Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure], CHARM [Candesartan in Heart Failure-Assessment of Reduction in Mortality], EuroSCORE [European System for Cardiac Operative Risk Evaluation], and PAINESD [Chronic Obstructive Pulmonary Disease, Age > 60 Years, Ischemic Cardiomyopathy, New York Heart Association Functional Class III or IV, Ejection Fraction <25%, Presentation With VT Storm, Diabetes Mellitus]) for the endpoints of death/cardiac transplantation and VT recurrence in 282 consecutive patients (age 59 ± 15 years, left ventricular ejection fraction: 36 ± 13%) with NIDCM undergoing CA of VT. Discrimination and calibration of each model were evaluated through area under the curve (AUC) of receiver-operating characteristic curve and goodness-of-fit test.
After a median follow-up of 48 (interquartile range: 19-67) months, 43 patients (15%) died, 24 (9%) underwent heart transplantation, and 58 (21%) experienced VT recurrence. The prognostic accuracy of SHFM (AUC = 0.89; goodness-of-fit p = 0.68 for death/transplant and AUC = 0.77; goodness-of-fit p = 0.16 for VT recurrence) and PAINESD (AUC = 0.83; goodness-of-fit p = 0.24 for death/transplant and AUC = 0.68; goodness-of-fit p = 0.58 for VT recurrence) were significantly superior to that of other scores.
In patients with NIDCM and VT undergoing CA, the SHFM and PAINESD risk scores are powerful predictors of recurrent VT and death/transplant during follow-up, with similar performance and significantly superior to other scores. A pre-procedural calculation of the SHFM and PAINESD can be useful to predict outcomes.
本研究旨在评估已建立的风险模型在预测非缺血性扩张型心肌病（NIDCM）伴室性心动过速（VT）患者经导管消融（CA）后的结局中的表现。
正确的术前风险分层对于 NIDCM 伴 VT 患者的 CA 至关重要。不同的术前风险分层方法预测 NIDCM 伴 VT 患者 CA 结局的表现尚不清楚。
该研究比较了 8 种预后评分（SHFM [西雅图心力衰竭模型]、MAGGIC [慢性心力衰竭荟萃分析全球组]、ADHERE [急性失代偿性心力衰竭国家注册]、EFFECT [有效心脏治疗的增强反馈-心力衰竭]、OPTIMIZE-HF [有组织计划启动心力衰竭住院患者的救生治疗]、CHARM [坎地沙坦在心力衰竭中的评估-降低死亡率]、EuroSCORE [欧洲心脏手术风险评估系统]和 PAINESD [慢性阻塞性肺疾病，年龄>60 岁，缺血性心肌病，纽约心脏协会功能分级 III 或 IV 级，射血分数<25%，VT 风暴发作，糖尿病]) 在 282 例连续接受 NIDCM 伴 VT 的 CA 治疗的患者（年龄 59 ± 15 岁，左心室射血分数：36 ± 13%）的死亡/心脏移植和 VT 复发终点的表现。通过接收者操作特征曲线下面积（AUC）和拟合优度检验评估每个模型的区分度和校准度。
中位随访 48 个月（四分位距：19-67 个月）后，43 例患者（15%）死亡，24 例（9%）接受心脏移植，58 例（21%）发生 VT 复发。SHFM（AUC=0.89；死亡/移植的拟合优度 p=0.68 和 AUC=0.77；VT 复发的拟合优度 p=0.16）和 PAINESD（AUC=0.83；死亡/移植的拟合优度 p=0.24 和 AUC=0.68；VT 复发的拟合优度 p=0.58）的预后准确性明显优于其他评分。
在接受 CA 的 NIDCM 伴 VT 患者中，SHFM 和 PAINESD 风险评分是预测随访期间 VT 复发和死亡/移植的有力指标，表现相似，明显优于其他评分。术前计算 SHFM 和 PAINESD 可用于预测结局。
