Risk scores in cardiac resynchronization therapy - a review of the literature

Cardiac resynchronization therapy (CRT) for selected heart failure (HF) patients improves symptoms and reduces morbidity and mortality; however, the prognosis of HF is still poor. There is an emerging need for tools that might help in optimal patient selection and provide prognostic information for patients and their families. Several risk scores have been created in recent years; although, no literature review is available that would list the possible scores for the clinicians. We identified forty-eight risk scores in CRT and provided the calculation methods and formulas in a ready-to-use format. The reviewed score systems can predict the prognosis of CRT patients; some of them have even provided an online calculation tool. Significant heterogeneity is present between the various risk scores in terms of the variables incorporated and some variables are not yet used in daily clinical practice. The lack of cross-validation of the risk scores limits their routine use and objective selection. As the number of prognostic markers of CRT is overwhelming, further studies might be required to analyze and cross-validate the data. </p

Baseline characteristics and left ventricular parameters of the studied populations.

Baseline characteristics and left ventricular parameters of the studied populations.</p

Representative cardiac MRI images of the studied populations in short axis view with the applied contouring technique and trabecular quantification.

Conventional, manually corrected semiautomatic contours with the threshold-based trabecular quantification method: the green area represents the left ventricular trabeculation, and the blue area represents the right ventricular trabeculation. DCM: dilated cardiomyopathy, LVNC-N: left ventricular noncompaction with good LV function, LVNC-R: left ventricular noncompaction with reduced LV function, RV-HT: right ventricle with hypertrabeculation, RV-NT: right ventricle with normal trabeculation. red line: left ventricular endocardial border, green line: left ventricular epicardial border, yellow line: right ventricular endocardial border, blue line: right ventricular epicardial border.</p

Comparison of the subgroups with normal RV trabeculation (NT) and with RV hypertrabeculation (HT) within the groups (values of the represented parameters are shown in S4 Table).

DCM-HT: dilated cardiomyopathy with right ventricular hypertrabeculation, DCM-NT: dilated cardiomyopathy with normal right ventricular trabeculation, LVNC-N-HT: left ventricular noncompaction with good left ventricular function and right ventricular hypertrabeculation, LVNC-N-NT: left ventricular noncompaction with good left ventricular function and normal right ventricular trabeculation, LVNC-R-HT: left ventricular noncompaction with reduced left ventricular function and right ventricular hypertrabeculation, LVNC-R-NT: left ventricular noncompaction with reduced left ventricular function and normal right ventricular trabeculation, RV-CMi: right ventricular end-diastolic compact myocardial mass index, RV-EDVi: right ventricular end-diastolic volume index, RV-EF: right ventricular ejection fraction, RV-ESVi: right ventricular end-systolic volume index, RV-FWS: right ventricular free-wall strain, RV-GLS: right ventricular global longitudinal strain, RV-SS: right ventricular septal strain, RV-SVi: right ventricular stroke volume index, RV-TMi: right ventricular end-diastolic trabecular and papillary muscle mass index.</p

Dataset.

BackgroundReports of left ventricular noncompaction (LVNC) rarely include descriptions of the right ventricle (RV). This study aimed to describe the characteristics of the RV in LVNC patients with reduced LV function (LVNC-R) compared with patients with dilated cardiomyopathy (DCM) and subjects with LVNC with normal left ventricular ejection fraction (LV-EF) (LVNC-N).MethodsForty-four LVNC-R patients, 44 LVNC-N participants, and 31 DCM patients were included in this retrospective study (LV-EF: LVNC-R: 33.4±10.2%; LVNC-N: 65.0±5.9%; DCM: 34.6±7.9%). Each group was divided into two subgroups by the amount of RV trabeculation.ResultsThere was no difference in the RV-EF between the groups, and the RV trabecular mass correlated positively with the RV volume and negatively with the RV-EF in all the groups. All the measured parameters were comparable between the groups with decreased LV function. The hypertrabeculated RV subgroups showed significantly higher RV volumes and lower RV-EF only in the decreased-LV-function groups. The correlation of LV and RV trabeculation was observed only in the LVNC-N group, while LV trabeculation correlated with RV volumes in both noncompacted groups. Both decreased-LV-function groups had worse RV strain values than the LVNC-N group; however, RV strain values correlated with RV trabeculation predominantly in the LVNC-R group.ConclusionsThe presence and characteristics of RV hypertrabeculation and the correlations between LV trabeculation and RV parameters raise the possibility of RV involvement in noncompaction; moreover, RV strain values might be helpful in the early detection of RV function deterioration.</div

Interobserver variability: The intraclass correlation coefficient was interpreted as less than 0.4, between 0.4 and 0.75, and greater than 0.75 indicated poor, fair to good and excellent interobserver agreement, respectively.

ICC: intraclass correlation coeffitients, RV-EDVi: right ventricular end-diastolic volume index, RV-ESVi: right ventricular end-systolic volume index, RV-SVi: right ventricular stroke volume index, RV-EF: right ventricular ejection fraction, RV-TotalMassi: right ventricular end-diastolic total myocardial mass index, RV-TMi: right ventricular end-diastolic trabecular and papillary muscle mass index, RV-GLS: right ventricular global longitudinal strain, RV-FWS: right ventricular free-wall strain, RV-SS: right ventricular septal strain. (DOCX)</p

Flowchart of the enrollment process.

Exclusion criteria: other technical reasons: implanted devices, arrhythmic or respiratory artifacts. comorbidities: ischemic, valvular, or congenital heart diseases, coexisting cardiomyopathies; hypertension, diabetes mellitus, endocrine disorders, chronic kidney or systemic diseases. intense sports activity: >6 hours/week. LVNC: left ventricular noncompaction, DCM: dilated cardiomyopathy, LV: left ventricle, LVNC-R: left ventricular noncompaction with reduced LV function, LVNC-N: left ventricular noncompaction with good LV function. (DOCX)</p

Right ventricular parameters of the studied populations and the prevalence of the hypertrabeculated subgroups in each population.

Right ventricular parameters of the studied populations and the prevalence of the hypertrabeculated subgroups in each population.</p

Correlations of the right ventricular parameters.

BackgroundReports of left ventricular noncompaction (LVNC) rarely include descriptions of the right ventricle (RV). This study aimed to describe the characteristics of the RV in LVNC patients with reduced LV function (LVNC-R) compared with patients with dilated cardiomyopathy (DCM) and subjects with LVNC with normal left ventricular ejection fraction (LV-EF) (LVNC-N).MethodsForty-four LVNC-R patients, 44 LVNC-N participants, and 31 DCM patients were included in this retrospective study (LV-EF: LVNC-R: 33.4±10.2%; LVNC-N: 65.0±5.9%; DCM: 34.6±7.9%). Each group was divided into two subgroups by the amount of RV trabeculation.ResultsThere was no difference in the RV-EF between the groups, and the RV trabecular mass correlated positively with the RV volume and negatively with the RV-EF in all the groups. All the measured parameters were comparable between the groups with decreased LV function. The hypertrabeculated RV subgroups showed significantly higher RV volumes and lower RV-EF only in the decreased-LV-function groups. The correlation of LV and RV trabeculation was observed only in the LVNC-N group, while LV trabeculation correlated with RV volumes in both noncompacted groups. Both decreased-LV-function groups had worse RV strain values than the LVNC-N group; however, RV strain values correlated with RV trabeculation predominantly in the LVNC-R group.ConclusionsThe presence and characteristics of RV hypertrabeculation and the correlations between LV trabeculation and RV parameters raise the possibility of RV involvement in noncompaction; moreover, RV strain values might be helpful in the early detection of RV function deterioration.</div

Clinical features of the studied patient groups.

DCM: dilated cardiomyopathy, LVNC-R: left ventricular noncompaction with reduced LV function, LVNC-N: left ventricular noncompaction with good LV function, ECG: electrocardiography. The bold values indicate statistical significances (p (DOCX)</p