Risk stratification in patients with cardiac resynchronisation therapy: the AL-FINE CRT risk score.

BACKGROUND: Mortality and morbidity in patients with cardiac resynchronisation therapy (CRT) remain very high. Prognostic evaluation of CRT candidates might be useful for the assessment of CRT indications, directing further therapy, counseling, etc. AIM: Our goal was to investigate the prognostic value of various parameters in order to construct a risk score that could predict long-term mortality and morbidity during the initial assessment of CRT candidates.

METHODS: This was a retrospective, single center, large cohort study including consecutive heart failure patients who underwent CRT device implantation. In order to build a prediction model, 28 parameters were analysed using uni - and multivariate Cox models and Kaplan-Meir survival curves.

RESULTS: Data from 552 patients was used for the long-term outcome assessment. During the 9 years of observation, 232 patients met the primary endpoint of death and 128 patients were hospitalised for heart failure. The strongest and clinically most relevant predictors were selected as the final model. AL-FINE is the acronym for these 6 predictors: Age ( > 75 years), non-LBBB morphology (according to Strauss criteria), Furosemide dose ( > 80 mg), Ischemic etiology, NYHA class ( > III) and left ventricular EF ( < 20%). Depending on the number of AL-FINE score points, overall mortality at 7 years was in the range of 28% (0-1 points) to 74% (3-6 points).

CONCLUSIONS: A novel, multiparametric CRT risk score was constructed on the basis of simple and recognised clinical, electrocardiographic and echocardiographic parameters that show a significant add-on effect on mortality in this specific population.