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Evaluating risk scores for CRT response and clinical outcomes: finding the ideal tool
Session:
SESSÃO DE POSTERS 49 - RESSINCRONIZAÇÃO CARDÍACA E TERAPÊUTICA MÉDICA
Speaker:
Isabel Moreira
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Cartazes
FP Number:
---
Authors:
Isabel Martins Moreira; Marta Catarina Bernardo; Luís Sousa Azevedo; Isabel Nóbrega Fernandes; José P. Guimarães; Sílvia Leão; Renato Margato; José Paulo Fontes; Inês Silveira; Ilídio Moreira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Introduction:</strong> Up to a third of heart failure (HF) patients do not respond to cardiac resynchronization therapy (CRT). Several risk scores have been proposed to predict outcomes in this population. However, a lack of cross-validation between these scores limits their integration into clinical practice. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Purpose:</strong> To assess the applicability of the <em>EAARN</em> (Ejection Fraction [EF], Age, Atrial Fibrillation [AF], Renal Dysfunction, New York Heart Association [NYHA] class IV), <em>AAACC</em> (Age, Anemia, AF, Chronic kidney disease [CKD] and Chronic Lung Disease [CLD]), and <em>AL-FINE</em> CRT risk score (Age, non-Left Bundle Branch Block [LBBB], Furosemide, Ischemic etiology, NYHA, EF) in predicting outcomes in a cohort of CRT patients.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Methods:</strong> Single-center retrospective study of consecutive pts submitted to CRT implantation (2017-2024). The discriminative capacity of the <em>EAARN, AAACC, </em> and <em>AL-FINE</em> scores was analysed for three endpoints: all-cause mortality, a composite endpoint of all-cause mortality or HF hospitalizations (MACE), and CRT response (defined as ≥10% EF increase and/or NYHA class improvement). Scores were evaluated using ROC curves and corresponding area under the curve (AUC).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong> A total of 206 patients (68.4% male, median age 74±13years, 67.5% non-ischemic cardiomyopathy) were included. Baseline QRS morphology was mainly LBBB (58.2%), with a mean QRS duration of 159.8±27.6ms and mean baseline LVEF of 30.3±7.5%. Comorbidities were prevalent, including AF (36.9%), anemia (34.4%), CKD (20.9%) and CLD (9.7%). Most patients were at NYHA class II (53.2%), with a median baseline furosemide dosage of 20±40mg. At 1-year follow-up, CRT response rate was 89.8%. During a mean follow-up of 35±24 months, MACE occurred in 31.9% of pts.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">The <em>AAACC</em> score demonstrated superior discriminative capacity compared to the <em>EAARN</em> and <em>AL-FINE</em> scores for predicting all-cause mortality (AUC <em>AAACC</em>: 0.71, 95% CI 0.62–0.80, p<0.001; <em>AL-FINE</em>: 0.65, 95% CI 0.56–0.74, p=0.002; <em>EAARN</em>: 0.63, 95% CI 0.53–0.73, p=0.009) and MACE (AUC <em>AAACC</em>: 0.68, 95% CI 0.59–0.77, p<0.001; <em>AL-FINE</em>: 0.65, 95% CI 0.56–0.74, p=0.002; <em>EAARN</em>: 0.59, 95% CI 0.50–0.69, p=0.063). However, <em>AL-FINE</em> was the best predictor for CRT response (AUC: 0.67, 95% CI 0.51–0.83, p=0.036) compared to <em>AAACC</em> (AUC: 0.59, 95% CI 0.42–0.76, p=0.313) and<em> EAARN</em> (AUC: 0.54, 95% CI 0.39–0.69, p=0.610). Optimal <em>AAACC</em> score cut-off was 1.5 (62.2% sensitivity, 71.6% specificity), with higher mortality observed in patients with score ≥1.5 (37.5% vs 15.1%, log-rank p<0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion:</strong> The <em>AL-FINE</em> score demonstrated superior predictive ability for CRT response, while <em>AAACC</em> score performed better for mortality and MACE. Nonetheless, all scores exhibited modest discriminative capacity, highlighting the need to optimize predictive tools for risk stratification in the current era of quadruple therapy for HFrEF.</span></span></p>
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