Author + information
- Sina Jame,
- Bronislava Polonsky,
- Scott McNitt,
- Amin Al-Ahmad,
- Arthur Moss,
- Wojciech Zareba and
- Paul Wang
This study aimed to determine the short-term prognostic value of consistently reduced device-derived activity levels.
Patients enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy) with CRT-D devices capable of recording weekly activity levels were included in this study. The MADIT-CRT enrolled those with left ventricular failure (class I and II with EF =30%) and prolonged QRS duration (=130 ms). To assess for temporal change, Standardized Activity Levels (SAL) were obtained comparing each weak to the monthly activity 3 months prior. Death was the primary end-point.
Of the 1008 patients assessed, 64 died within 12 weeks of the final device interrogation. Patients who died experienced a 50% decline in SAL over the final ten weeks prior to death. No change in SAL was seen in those who did not die. ROC curve analysis identified the minimum 3 consecutive week SAL average as the most optimal duration for prediction of death (AUC 0.809, Cl: 0.75-0.87, p<.0001) with 0.694 as cut-off threshold. The 70-day cumulative incidence of death from the first SAL below cut-off was determined using KM analysis. Patients with SAL =<0.694 (n=233) had a significantly increased incidence (25.6% vs. 1.6%, p<.0001) and risk (HR: 15.9, Cl: 7.6 to 33.6, p<.0001) of death compared to those who did not.
Three consecutive weeks of reduced standardized activity is a predictor of death in patients with mild to moderate heart failure.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Heart Failure: Cardiac Resynchronization Therapy
Abstract Category: 17. Heart Failure: Therapy
Presentation Number: 1177-309
- 2013 American College of Cardiology Foundation