Usefulness of the Vall D'Hebron Risk Score to Stratify the Risk of Patients with Ischemic Cardiomyopathy

Overview

Journal J Nucl Cardiol

Specialty Cardiology & Vascular Diseases

Date 2022 Aug 8

PMID 35941322

Authors

Guillermo Romero-Farina

Santiago Aguade-Bruix

Eduard Rodenas-Alesina

Lorena Herrador

Pablo Jordan

Ignacio Ferreira-Gonzalez

Affiliations

Soon will be listed here.

Abstract

Background: To evaluate the Vall d'Hebron-Risk-Score (VH-RS) to stratify the risk of patients with stable ischemic cardiomyopathy (ICM), and assess whether hemoglobin (Hb) and estimated glomerular filtration rate (eGFR) provide additional information to the VH-RS.

Methods And Results: We analysed 673 consecutive patients with ICM who underwent gated SPECT. According to VH-RS, we stratified patients into 4-risk-levels: very-low-risk (VLR), low-risk (LR), moderate-risk (MR), and high-risk (HRi). We considered as MACEs: non-fatal myocardial infarction (MI), heart failure hospitalization (HF), coronary revascularization (CR), and cardiac death (CD). Also the cardiac-resynchronization-therapy (CRT), and the implantable-cardioverter-defibrillator (ICD) were investigated. During the follow-up (4.8 ± 2.7 years), 379 patients had MACEs (0.18/patient/year). There were no patients in VLR and LR. All patients were reclassified in 3-risk-levels (MRi = 48; HRi = 121; VHRi[very high risk] = 504). Most patients with MACEs were in VHRi level (test-for-trend: MACEs ≥ 1 without CRT/ICD, P < .001; combined non-fatal MI, CD and CR, P < .001; MACEs ≥ 1 with CRT/ICD, P < .001). The Hb and eGFR values do not properly improve the risk stratification obtained by the VH-RS (global-NRI[net-reclassification-improvement] was: (MACEs ≥ 1 without CRT/ICD: - 10.6%; non-fatal MI, CD and CR: - 9.08%; and MACEs ≥ 1 with CRT/ICD: - 8.85%).

Conclusion: VH-RS is effective in evaluating risk of patients with stable ICM. In our population, adding Hb and eGFR variables do not improve the performance of the VH-RS.

Citing Articles

Vall d'Hebron Risk Score II for myocardial infarction and cardiac death.

Romero-Farina G, Aguade-Bruix S, Ferreira Gonzalez I Open Heart. 2023; 10(2).

PMID: 37935561 PMC: 10632909. DOI: 10.1136/openhrt-2023-002431.

References

Candell-Riera J, Romero-Farina G, Aguade-Bruix S, Castell-Conesa J, Leon G, Garcia-Dorado D . Prognostic value of myocardial perfusion-gated SPECT in patients with ischemic cardiomyopathy. J Nucl Cardiol. 2009; 16(2):212-21. DOI: 10.1007/s12350-008-9042-0. View

Zelt J, Wang J, Mielniczuk L, Beanlands R, Fallavollita J, Canty Jr J . Positron Emission Tomography Imaging of Regional Versus Global Myocardial Sympathetic Activity to Improve Risk Stratification in Patients With Ischemic Cardiomyopathy. Circ Cardiovasc Imaging. 2021; 14(6):e012549. PMC: 8208501. DOI: 10.1161/CIRCIMAGING.121.012549. View

AlJaroudi W, Alraies M, Menon V, Brunken R, Cerqueira M, Jaber W . Predictors and incremental prognostic value of left ventricular mechanical dyssynchrony response during stress-gated positron emission tomography in patients with ischemic cardiomyopathy. J Nucl Cardiol. 2012; 19(5):958-69. DOI: 10.1007/s12350-012-9592-z. View

Chery G, Kamp N, Kosinski A, Sanders Schmidler G, Lopes R, Patel M . Prognostic value of myocardial fibrosis on cardiac magnetic resonance imaging in patients with ischemic cardiomyopathy: A systematic review. Am Heart J. 2020; 229:52-60. PMC: 7417269. DOI: 10.1016/j.ahj.2020.08.004. View

Lee C, Hung K, Chen C, Chu C, Hsieh M, Chang P . A novel echocardiographic parameter for predicting the ischemic etiology of cardiomyopathy and its prognosis in patients with congestive heart failure. J Am Soc Echocardiogr. 2011; 24(12):1349-57. DOI: 10.1016/j.echo.2011.08.020. View

Katritsis D, Zografos T, Hindricks G . Electrophysiology testing for risk stratification of patients with ischaemic cardiomyopathy: a call for action. Europace. 2017; 20(FI2):f148-f152. DOI: 10.1093/europace/eux305. View

Waldum B, Westheim A, Sandvik L, Flonaes B, Grundtvig M, Gullestad L . Baseline anemia is not a predictor of all-cause mortality in outpatients with advanced heart failure or severe renal dysfunction. Results from the Norwegian Heart Failure Registry. J Am Coll Cardiol. 2012; 59(4):371-8. DOI: 10.1016/j.jacc.2011.10.864. View

McAlister F, Ezekowitz J, Tonelli M, Armstrong P . Renal insufficiency and heart failure: prognostic and therapeutic implications from a prospective cohort study. Circulation. 2004; 109(8):1004-9. DOI: 10.1161/01.CIR.0000116764.53225.A9. View

Romero-Farina G, Candell-Riera J, Aguade-Bruix S, Dorado D . A novel clinical risk prediction model for myocardial infarction, coronary revascularization, and cardiac death according to clinical, exercise, and gated SPECT variables (VH-RS). Eur Heart J Cardiovasc Imaging. 2019; 21(2):210-221. DOI: 10.1093/ehjci/jez078. View

10.

Felker G, Shaw L, OConnor C . A standardized definition of ischemic cardiomyopathy for use in clinical research. J Am Coll Cardiol. 2002; 39(2):210-8. DOI: 10.1016/s0735-1097(01)01738-7. View

11.

Damman K, Tang W, Felker G, Lassus J, Zannad F, Krum H . Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency: practical considerations from published data. J Am Coll Cardiol. 2013; 63(9):853-71. DOI: 10.1016/j.jacc.2013.11.031. View

12.

Pencina M, DAgostino Sr R, DAgostino Jr R, Vasan R . Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med. 2007; 27(2):157-72. DOI: 10.1002/sim.2929. View

13.

Pencina M, DAgostino Sr R, Steyerberg E . Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers. Stat Med. 2011; 30(1):11-21. PMC: 3341973. DOI: 10.1002/sim.4085. View

14.

Tang Y, Katz S . Anemia in chronic heart failure: prevalence, etiology, clinical correlates, and treatment options. Circulation. 2006; 113(20):2454-61. DOI: 10.1161/CIRCULATIONAHA.105.583666. View

15.

Lindenfeld J . Prevalence of anemia and effects on mortality in patients with heart failure. Am Heart J. 2005; 149(3):391-401. DOI: 10.1016/j.ahj.2004.08.039. View

16.

Anand I, McMurray J, Whitmore J, Warren M, Pham A, McCamish M . Anemia and its relationship to clinical outcome in heart failure. Circulation. 2004; 110(2):149-54. DOI: 10.1161/01.CIR.0000134279.79571.73. View

17.

Mentz R, Greene S, Ambrosy A, Vaduganathan M, Subacius H, Swedberg K . Clinical profile and prognostic value of anemia at the time of admission and discharge among patients hospitalized for heart failure with reduced ejection fraction: findings from the EVEREST trial. Circ Heart Fail. 2014; 7(3):401-8. PMC: 4151504. DOI: 10.1161/CIRCHEARTFAILURE.113.000840. View

18.

OMeara E, Rouleau J, White M, Roy K, Blondeau L, Ducharme A . Heart failure with anemia: novel findings on the roles of renal disease, interleukins, and specific left ventricular remodeling processes. Circ Heart Fail. 2014; 7(5):773-81. DOI: 10.1161/CIRCHEARTFAILURE.114.001100. View

19.

Dries D, Exner D, Domanski M, Greenberg B, Stevenson L . The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol. 2000; 35(3):681-9. DOI: 10.1016/s0735-1097(99)00608-7. View

20.

Tedeschi A, Agostoni P, Pezzuto B, Corra U, Scrutinio D, La Gioia R . Role of comorbidities in heart failure prognosis Part 2: Chronic kidney disease, elevated serum uric acid. Eur J Prev Cardiol. 2020; 27(2_suppl):35-45. PMC: 7691631. DOI: 10.1177/2047487320957793. View