4.6 Article

The MADIT-ICD benefit score helps to select implantable cardioverter-defibrillator candidates in cardiac resynchronization therapy

期刊

EUROPACE
卷 24, 期 8, 页码 1276-1283

出版社

OXFORD UNIV PRESS
DOI: 10.1093/europace/euac039

关键词

Heart failure; Implantable cardioverter-defibrillator; Cardiac resynchronization therapy; Patient selection; MADIT-ICD benefit score

资金

  1. foundation Limburg Sterk Merk (LSM)
  2. Province of Limburg
  3. Flemish Government
  4. Hasselt University
  5. Ziekenhuis Oost-Limburg
  6. Jessa Hospital
  7. Fund for Scientific Research Flanders [FWO1S83221N]

向作者/读者索取更多资源

The aim of this study was to evaluate the predictive ability of the MADIT-ICD benefit score in identifying heart failure patients who would benefit most from CRT-D and compare it with a multidisciplinary expert centre approach. The results showed that the MADIT-ICD benefit score can identify patients who would benefit most from CRT-D and its predictive power is comparable to multidisciplinary judgement.
Aims The aim of this study is to evaluate whether the MADIT-ICD benefit score can predict who benefits most from the addition of implantable cardioverter-defibrillator (ICD) to cardiac resynchronization therapy (CRT) in real-world patients with heart failure with reduced ejection fraction (HFrEF) and to compare this with selection according to a multidisciplinary expert centre approach. Methods and results Consecutive HFrEF patients who received a CRT for a guideline indication at a tertiary care hospital (Ziekenhuis Oost-Limburg, Genk, Belgium) between October 2008 and September 2016, were retrospectively evaluated. The MADIT-ICD benefit groups (low, intermediate, and high) were compared with the current multidisciplinary expert centre approach. Endpoints were (i) sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and (ii) non-arrhythmic mortality. Of the 475 included patients, 165 (34.7%) were in the lowest, 220 (46.3%) in the intermediate, and 90 (19.0%) in the highest benefit group. After a median follow-up of 34 months, VT/VF occurred in 3 (1.8%) patients in the lowest, 9 (4.1%) in the intermediate, and 13 (14.4%) in the highest benefit group (P < 0.001). Vice versa, non-arrhythmic death occurred in 32 (19.4%) in the lowest, 32 (14.6%) in the intermediate, and 3 (3.3%) in the highest benefit group (P = 0.002). The predictive power for ICD benefit was comparable between expert multidisciplinary judgement and the MADIT-ICD benefit score: Uno's C-statistic 0.69 vs. 0.69 (P = 0.936) for VT/VF and 0.62 vs. 0.60 (P = 0.790) for non-arrhythmic mortality. Conclusion The MADIT-ICD benefit score can identify who benefits most from CRT-D and is comparable with multidisciplinary judgement in a CRT expert centre.

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