Validation of the VT-LVAD score for prediction of late VAs in LVAD recipients

Angeliki Darma (1) , Arash Arya (1) , Nikolaos Dagres (1) , Michael Kuehl (2) , Gerhard Hindricks (1) , Sandra Eifert (1) , Diyar Saeed (1) , Michael Borger (1) , Raphael P. Martins (3, 4) , Christophe Leclercq (3, 4) , Vincent Galand (3, 4)

1 Heart Centre Leipzig
2 University Hospital Coventry
3 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
4 LTSI - Laboratoire Traitement du Signal et de l'Image

Objectives This study sought to validate the performance of the VT-LVAD risk model in predicting late ventricular arrhythmias (VAs) in patients after left ventricular assist device (LVAD) implantation. Background The need for implantable cardioverter-defibrillator (ICD)-implantation in LVAD recipients is not well studied. A better selection of the patients with high risk for late VAs could lead to a more targeted ICD-implantation or replacement. Methods The study evaluated the performance of the VT-LVAD prognostic score (VAs prior LVAD, no ACE-inhibitor in medication, heart failure duration > 12 months, early VAs post-LVAD implantation, atrial fibrillation prior LVAD, idiopathic dilated cardiomyopathy) for the endpoint of the occurrence of late VAs in 357 LVAD patients in Heart Centre of Leipzig. Results From the initial 460 patients, 357 (age: 58 +/- 10 years; left ventricular ejection fraction: 20 +/- 6%; HeartWare: 50%; HeartMate III: 42%) were assigned to four risk groups according to their VT-LVAD score varying from low risk to very high risk. After 25 months, late VAs occurred in 130 patients. The VT-LVAD score was an independent predictor of late VAs (multivariate analysis; p = < .001; goodness-of-tip p = .347; odds ratio: 4.8). While there was no statistically significant difference between the low- and intermediate-risk group, risk stratification for patients with high risk and very high risk performed more accurately (pairwise comparison p = .005 and p < .001, respectively). Conclusions The VT-LVAD score predicted accurately the occurrence of late VAs in high-risk LVAD recipients in a large external cohort of LVAD recipients supporting its utility for more targeted ICD implantations.

Mots clés: ICD; late ventricular arrhythmia; LVAD; mortality; risk stratification

Domaines: Ingénierie biomédicale; Cardiologie et système cardiovasculaire

Angeliki Darma, Arash Arya, Nikolaos Dagres, Michael Kuehl, Gerhard Hindricks, et al.. Validation of the VT-LVAD score for prediction of late VAs in LVAD recipients. Journal of Cardiovascular Electrophysiology, 2021, 32 (2), pp.515-522. ⟨10.1111/jce.14827⟩. ⟨hal-03095616⟩