Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany.
Department of Cardiology, University Hospitals of Coventry and Warwickshire, Coventry, UK.
J Cardiovasc Electrophysiol. 2021 Feb;32(2):515-522. doi: 10.1111/jce.14827. Epub 2020 Dec 11.
This study sought to validate the performance of the VT-LVAD risk model in predicting late ventricular arrhythmias (VAs) in patients after left ventricular assist device (LVAD) implantation.
The need for implantable cardioverter-defibrillator (ICD)-implantation in LVAD recipients is not well studied. A better selection of the patients with high risk for late VAs could lead to a more targeted ICD-implantation or replacement.
The study evaluated the performance of the VT-LVAD prognostic score (VAs prior LVAD, no ACE-inhibitor in medication, heart failure duration > 12 months, early VAs post-LVAD implantation, atrial fibrillation prior LVAD, idiopathic dilated cardiomyopathy) for the endpoint of the occurrence of late VAs in 357 LVAD patients in Heart Centre of Leipzig.
From the initial 460 patients, 357 (age: 58 ± 10 years; left ventricular ejection fraction: 20 ± 6%; HeartWare: 50%; HeartMate III: 42%) were assigned to four risk groups according to their VT-LVAD score varying from low risk to very high risk. After 25 months, late VAs occurred in 130 patients. The VT-LVAD score was an independent predictor of late VAs (multivariate analysis; p = < .001; goodness-of-tip p = .347; odds ratio: 4.8). While there was no statistically significant difference between the low- and intermediate-risk group, risk stratification for patients with high risk and very high risk performed more accurately (pairwise comparison p = .005 and p < .001, respectively).
The VT-LVAD score predicted accurately the occurrence of late VAs in high-risk LVAD recipients in a large external cohort of LVAD recipients supporting its utility for more targeted ICD implantations.
本研究旨在验证 VT-LVAD 风险模型在预测左心室辅助装置（LVAD）植入后患者晚期室性心律失常（VA）的性能。
LVAD 受者中植入式心脏复律除颤器（ICD）的需求尚未得到充分研究。更好地选择晚期 VA 风险较高的患者，可能会导致更有针对性的 ICD 植入或更换。
该研究评估了 VT-LVAD 预后评分（LVAD 前 VA、药物中无 ACE 抑制剂、心力衰竭持续时间>12 个月、LVAD 后早期 VA、LVAD 前房颤、特发性扩张型心肌病）在预测 357 例 LVAD 患者发生晚期 VA 的终点事件中的表现，该研究在莱比锡心脏中心进行。
从最初的 460 例患者中，根据其 VT-LVAD 评分（范围从低危到高危），将 357 例患者（年龄：58±10 岁；左心室射血分数：20±6%；HeartWare：50%；HeartMate III：42%）分为四个风险组。25 个月后，130 例患者发生晚期 VA。VT-LVAD 评分是晚期 VA 的独立预测因子（多变量分析；p<0.001；拟优检验 p=0.347；优势比：4.8）。虽然低危和中危组之间没有统计学上的显著差异，但对高危和极高危患者进行风险分层的准确性更高（两两比较 p=0.005 和 p<0.001）。
VT-LVAD 评分在大型 LVAD 受者外部队列中准确预测了高危 LVAD 受者晚期 VA 的发生，支持其用于更有针对性的 ICD 植入。
