Department of Cardiology, Institution for Clinical Sciences, Lund University, Lund, Sweden.
Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.
Cardiology. 2021;146(4):453-463. doi: 10.1159/000513955. Epub 2021 May 7.
Cardiac resynchronization therapy (CRT) is commonly used in patients with heart failure and left ventricular dyssynchrony. Several scoring systems have been tested in order to predict long-term outcome. Although intended for use in patients with atrial fibrillation, we sought to assess the performance of the CHA2DS2-VASc score in a CRT population.
Data on 796 consecutive CRT patients were retrospectively gathered from hospital records and healthcare registries. CHA2DS2-VASc scores were calculated, as well as other stratification scores for comparison. The outcomes were crude mortality, time to first heart failure hospitalization, and a composite of the 2. CHA2DS2-VASc score was evaluated against the end points with survival analyses and compared to other risk stratification scores.
The CHA2DS2-VASc score was significantly correlated with both outcomes in univariable and multivariable analysis adjusting for other known predictors of CRT outcome (unadjusted HR 1.28, 95% CI 1.21-1.36 and HR 1.19, 95% CI 1.13-1.25 for the mortality and heart failure hospitalization end points, respectively). Its performance compared well to other validated scores for the mortality end point (Harrell's C: 0.61, range for other scoring systems: 0.57-0.65), as well as the heart failure hospitalization end point (Harrell's C: 0.57, range of other scoring systems: 0.58-0.62). It correlated to 5- and 10-year survival with an area under the curve of 0.63 and 0.73, respectively.
When tested for association with outcome in a CRT population, the CHA2DS2-VASc score correlates to increased mortality and risk of heart failure hospitalization. It performs similarly to CRT-specific scores. However, the results of this study indicate that all tested scores should be used with caution in CRT patients.
心脏再同步治疗（CRT）常用于心力衰竭和左心室不同步的患者。已经测试了几种评分系统来预测长期预后。尽管该评分系统旨在用于房颤患者，但我们试图评估 CHA2DS2-VASc 评分在 CRT 人群中的表现。
回顾性地从医院记录和医疗保健登记处收集了 796 例连续 CRT 患者的数据。计算了 CHA2DS2-VASc 评分，并比较了其他分层评分。结果是总死亡率、首次心力衰竭住院时间以及两者的复合终点。使用生存分析评估 CHA2DS2-VASc 评分与终点的相关性，并与其他风险分层评分进行比较。
CHA2DS2-VASc 评分在单变量和多变量分析中均与两个终点显著相关，调整了 CRT 预后的其他已知预测因素（未调整的 HR 分别为 1.28、95%CI 为 1.21-1.36 和 HR 为 1.19、95%CI 为 1.13-1.25）。与其他经过验证的死亡率终点评分相比，其性能良好（Harrell's C：0.61，其他评分系统范围：0.57-0.65），以及心力衰竭住院终点（Harrell's C：0.57，其他评分系统范围：0.58-0.62）。它与 5 年和 10 年生存率的曲线下面积分别为 0.63 和 0.73 相关。
在 CRT 人群中测试与结局的相关性时，CHA2DS2-VASc 评分与死亡率增加和心力衰竭住院风险相关。它与 CRT 特异性评分的表现相似。然而，本研究的结果表明，所有测试的评分在 CRT 患者中都应谨慎使用。
