Author + information
- Received December 10, 2018
- Revision received March 27, 2019
- Accepted April 18, 2019
- Published online May 7, 2019.
- Daniele Muser, MDa,
- Jackson J. Liang, DOa,
- Simon A. Castro, MDa,
- Corrado Lanera, MSb,
- Andres Enriquez, MDa,
- Ling Kuo, MDa,
- Silvia Magnani, MDa,
- Edo Y. Birati, MDc,
- David Lin, MDa,
- Robert Schaller, DOa,
- Gregory Supple, MDa,
- Erica Zado, PA-Ca,
- Fermin C. Garcia, MDa,
- Saman Nazarian, MDa,
- Sanjay Dixit, MDa,
- David Frankel, MDa,
- David J. Callans, MDa,
- Francis E. Marchlinski, MDa and
- Pasquale Santangeli, MD, PhDa,∗ ()
- aCardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- bUnit of Biostatistics, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
- cAdvanced Heart Failure Unit, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. Pasquale Santangeli, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, 9 Founders Pavilion—Cardiology, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
Objectives 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).
Background 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.
Methods 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.
Results 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.
Conclusions 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.
- catheter ablation
- dilated cardiomyopathy
- electroanatomical mapping
- heart failure
- ventricular tachycardia
This study is funded by The Richard T. and Angela Clark Innovation Fund in Cardiac Electrophysiology. Dr. Birati is a consultant for American Regent, Inc. Dr. Nazarian is a consultant for Biosense Webster, CardioSolv, Siemens, and ImriCor; and a principal investigator for St. Jude Medical (Abbott) MRI Ready Study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received December 10, 2018.
- Revision received March 27, 2019.
- Accepted April 18, 2019.
- 2019 American College of Cardiology Foundation
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