A Novel Risk Model for Mortality and Hospitalization following Cardiac Resynchronization Therapy in Patients with Non-ischemic Cardiomyopathy: The Alpha-score

Abstract Background: Non-ischemic cardiomyopathy (NICM) has been associated with a better left ventricle reverse remodeling response and improved clinical outcomes after cardiac resynchronization therapy (CRT). The aims of our study were to identify the predictors of mortality and heart failure hospitalization in patients treated with CRT and design a risk score for prognosis. Methods: A cohort of 422 consecutive NICM patients with CRT was retrospectively enrolled between January 2010 and December 2017. The primary endpoint was all-cause mortality and heart transplantation. Results: In a multivariate analysis, the predictors of all-cause death were left atrial diameter [Hazard ratio (HR): 1.056, 95% confidence interval (CI): 1.020-1.093, P=0.002]; non-left bundle branch block [HR: 1.793, 95% CI: 1.131-2.844, P =0.013]; high sensitivity C-reactive protein [HR: 1.081, 95% CI: 1.029-1.134 P= 0.002]; and N-terminal pro-B-type natriuretic peptide [HR: 1.018, 95% CI: 1.007-1.030, P =0.002]; and New York Heart Association class IV [HR: 1.018, 95% CI: 1.007-1.030, P =0.002]. The Alpha-score ( A trial diameter, non- L BBB, P ro-BNP, H s-CRP, NYH A class IV) was derived from each independent risk factor. The novel score had good calibration (Hosmer-Lemeshow, P >0.05) and discrimination for both primary endpoints [c-statistics: 0.749 (95% CI: 0.694-0.804), P <0.001] or heart failure hospitalization [c-statistics: 0.692 (95% CI: 0.639-0.745), P <0.001]. Conclusion: The Alpha-score may enable improved discrimination and accurate prediction of long-term outcomes among NICM patients with CRT.