Journal article
Prediction of Survival After Implantation of a Fully Magnetically Levitated Left Ventricular Assist Device
JACC. Heart failure, v 10(12), pp 948-959
Dec 2022
PMID: 36456068
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Clinical trials inform on average efficacy, but individualized risk assessments for outcome prediction are important in guiding treatment implementation.
The authors developed and validated a patient-specific risk score to predict survival at 1 and 2 years after HeartMate 3 (HM3) left ventricular assist device (LVAD) implantation.
The MOMENTUM 3 (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3) trial includes 2,200 HM3 LVAD patients in the pivotal trial and Continued Access Protocol study (2014-2018). The authors randomly assigned all patients to a derivation cohort (n = 1,540) or validation cohort (n = 660). Univariate mortality predictors were screened for potential model inclusion, stepwise selection was used to build the multivariable Cox proportional hazards regression model, and performance (discrimination and calibration) was evaluated.
Age, prior cardiac surgery (coronary artery bypass grafting [CABG] or valve procedure), lower serum sodium, higher blood urea nitrogen (BUN), small left ventricular size, and right atrial pressure-to-pulmonary capillary wedge pressure (RAP/PCWP) ratio >0.6 were significant risk factors for mortality. Receiver-operating characteristic (ROC) analysis in the validation cohort demonstrated an area under the curve (AUC) of 0.76 (95% CI: 0.70-0.81) at 1 year and 0.71 (95% CI: 0.66-0.77) at 2 years. Calibration between predicted and observed survival of the risk quintiles was high, with Pearson correlation coefficients of 0.986 and 0.994 at 1 and 2 years, respectively. Patients were successfully stratified into tertiles with higher-than-average, average, and lower-than-average survival, and observed mortality risk increased by 2-fold from one tertile to the next.
A practical, easy-to-use HM3 Survival Risk Score with 6 components was developed to accurately predict 1- and 2-year survival after HM3 LVAD implantation. The survival risk score can be used to provide individual survival estimates to facilitate shared decision making when considering HM3 LVAD therapy. (MOMENTUM 3 Trial Portfolio; NCT02224755, NCT02892955).
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Details
- Title
- Prediction of Survival After Implantation of a Fully Magnetically Levitated Left Ventricular Assist Device
- Creators
- Mandeep R Mehra - Brigham and Women's HospitalAditi Nayak - Emory UniversityAlanna A Morris - Emory UniversityDavid E Lanfear - Henry Ford HospitalHassan Nemeh - Henry Ford HospitalSapna Desai - Ochsner Medical CenterAditya Bansal - Ochsner Medical CenterCesar Guerrero-Miranda - Baylor University Medical CenterShelley Hall - Baylor University Medical CenterJoseph C Cleveland, Jr - University of Colorado School of Medicine, Aurora, Colorado, USADaniel J Goldstein - Albert Einstein College of MedicineNir Uriel - Columbia UniversityLeway Chen - University of Rochester Medical CenterStephen Bailey - Allegheny Health NetworkAnelechi Anyanwu - Icahn School of Medicine at Mount SinaiGerald Heatley - AbbottJoyce Chuang - AbbottJerry D Estep - Cleveland Clinic Florida
- Publication Details
- JACC. Heart failure, v 10(12), pp 948-959
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Cardiothoracic Surgery
- Web of Science ID
- WOS:000904945500008
- Scopus ID
- 2-s2.0-85140775602
- Other Identifier
- 991021960812904721
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- Collaboration types
- Industry collaboration
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems