{"title":"A Practical Scoring System for Estimating Ventricular Arrhythmia Events in Patients with Cardiac Resynchronization Therapy for Primary Prevention.","authors":"Takayuki Goto, Yasuya Inden, Satoshi Yanagisawa, Naoki Tsurumi, Kiichi Miyamae, Hiroyuki Miyazawa, Shun Kondo, Masaya Tachi, Tomoya Iwawaki, Ryota Yamauchi, Kei Hiramatsu, Masafumi Shimojo, Yukiomi Tsuji, Toyoaki Murohara","doi":"10.1536/ihj.24-646","DOIUrl":null,"url":null,"abstract":"<p><p>The prognostic value of defibrillators in cardiac resynchronization therapy (CRT) for primary prevention remains debatable. Predicting ventricular arrhythmias (VAs) before implantation is useful for deciding whether to add a defibrillator to a CRT device. This study aimed to determine the risk factors for VA events after CRT device implantation and to construct a scoring model. A total of 153 patients who underwent CRT device implantation, with no history of sustained ventricular tachycardia or ventricular fibrillation (including 25 patients with CRT pacemakers) and with follow-up period >1 year after implantation were included. We assessed VA events requiring implantable cardioverter-defibrillator therapy and sustained VA events requiring clinical treatment. During a mean follow-up of 6.3 years, 24 patients (16%) received therapy for VA. Multivariate analysis revealed age ≤ 70 years (hazard ratio [HR] 2.936, P = 0.037), administration of tolvaptan (HR 11.259, P < 0.001), and coronary artery disease (HR 2.444, P = 0.045) were independent predictors for VA events. Risk scores were assigned based on the HR for each predictor, and the population was divided into 3 risk groups (low: 0 points; moderate: 1-3 points; high: 4-5 points). VAs occurred less frequently in the low-risk group than in the other risk groups (low: 8.1%; moderate: 18%; high: 21%) (log-rank, P < 0.001). No significant differences in mortality were observed between the groups, whereas hospitalization for heart failure occurred more frequently in the high-risk group than in the other groups. In conclusion, a scoring system using specific background information may help predict VA events in prophylactic CRT recipients.</p>","PeriodicalId":13711,"journal":{"name":"International heart journal","volume":" ","pages":"241-251"},"PeriodicalIF":1.2000,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International heart journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1536/ihj.24-646","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/15 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
The prognostic value of defibrillators in cardiac resynchronization therapy (CRT) for primary prevention remains debatable. Predicting ventricular arrhythmias (VAs) before implantation is useful for deciding whether to add a defibrillator to a CRT device. This study aimed to determine the risk factors for VA events after CRT device implantation and to construct a scoring model. A total of 153 patients who underwent CRT device implantation, with no history of sustained ventricular tachycardia or ventricular fibrillation (including 25 patients with CRT pacemakers) and with follow-up period >1 year after implantation were included. We assessed VA events requiring implantable cardioverter-defibrillator therapy and sustained VA events requiring clinical treatment. During a mean follow-up of 6.3 years, 24 patients (16%) received therapy for VA. Multivariate analysis revealed age ≤ 70 years (hazard ratio [HR] 2.936, P = 0.037), administration of tolvaptan (HR 11.259, P < 0.001), and coronary artery disease (HR 2.444, P = 0.045) were independent predictors for VA events. Risk scores were assigned based on the HR for each predictor, and the population was divided into 3 risk groups (low: 0 points; moderate: 1-3 points; high: 4-5 points). VAs occurred less frequently in the low-risk group than in the other risk groups (low: 8.1%; moderate: 18%; high: 21%) (log-rank, P < 0.001). No significant differences in mortality were observed between the groups, whereas hospitalization for heart failure occurred more frequently in the high-risk group than in the other groups. In conclusion, a scoring system using specific background information may help predict VA events in prophylactic CRT recipients.
除颤器在心脏再同步化治疗(CRT)中用于一级预防的预后价值仍有争议。在植入前预测室性心律失常(VAs)对于决定是否在CRT设备中添加除颤器是有用的。本研究旨在确定CRT装置植入后VA事件的危险因素,并建立评分模型。153例接受CRT装置植入的患者,无持续性室性心动过速或室性颤动病史(其中25例使用CRT起搏器),植入后随访时间为10 ~ 10年。我们评估了需要植入式心律转复除颤器治疗的VA事件和需要临床治疗的持续性VA事件。在平均6.3年的随访中,24例(16%)患者接受了VA治疗,多因素分析显示年龄≤70岁(风险比[HR] 2.936, P = 0.037)、托伐普坦(HR 11.259, P < 0.001)和冠状动脉疾病(HR 2.444, P = 0.045)是VA事件的独立预测因素。根据每个预测因子的HR进行风险评分,并将人群分为3个风险组(低:0分;适中:1-3分;高:4-5分)。低危组VAs发生率低于其他危组(低危组:8.1%;中度:18%;高:21%)(log-rank, P < 0.001)。两组之间的死亡率无显著差异,而高危组因心力衰竭住院的发生率高于其他组。总之,使用特定背景信息的评分系统可能有助于预测预防性CRT接受者的VA事件。
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