Author + information
- Received October 27, 2014
- Accepted November 25, 2014
- Published online April 1, 2015.
- Luigi Adamo, MD, PhD∗,
- Michael Nassif, MD∗,
- Anjan Tibrewala, MD†,
- Eric Novak, MS∗,
- Justin Vader, MD, MPHS∗,
- Scott C. Silvestry, MD‡,
- Akinobu Itoh, MD, PhD‡,
- Gregory A. Ewald, MD∗,
- Douglas L. Mann, MD∗ and
- Shane J. LaRue, MD, MPHS∗∗ ()
- ∗Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
- †Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- ‡Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
- ↵∗Reprint requests and correspondence:
Dr. Shane J. LaRue, Cardiovascular Division, Washington University School of Medicine, Campus Box 8086, 660 South Euclid Avenue, St. Louis, Missouri 63110.
Objectives This study evaluated the Heartmate Risk Score (HMRS) and its potential benefits in clinical practice.
Background The HMRS has been shown to correlate with mortality in the cohort of patients enrolled in the Heartmate II trials, but its validity in unselected, “real world” populations remains unclear.
Methods This study identified a cohort of 269 consecutive patients who received a Heartmate II left ventricular assist device at our institution, the Barnes-Jewish Hospital in St. Louis, Missouri, between June 2005 and June 2013. Ninety-day and 2-year mortality rates, as well as frequency of several morbid events, were compared by retrospectively assigned HMRS category groups. The analysis was repeated within the subgroup of INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) class 1 patients.
Results Receiver operating curve analysis showed that the HMRS correlated with 90-day mortality with an area under the curve of 0.70. Stratification in low, mid, and high HMRS groups identified patients with increasing hazard of 90-day mortality, increasing long-term mortality, increasing rate of gastrointestinal bleeding events, and increasing median number of days spent in the hospital in the first year post implant. Within INTERMACS class 1 patients, those in the highest HMRS group were found to have a relative risk of 90-day mortality 5.7 times higher than those in the lowest HMRS group (39.1% vs. 6.9%, p = 0.029).
Conclusions HMRS is a valid clinical tool to stratify risk of morbidity and mortality after implant of Heartmate II devices in unselected patients and can be used to predict short-term mortality risk in INTERMACS class 1 patients.
This study was supported in part by research funds from the National Institutes of Health (NIH grant U10 HL110309, Heart Failure Network, and the Washington University Institute of Clinical and Translational Sciences grant UL1TR000448 from the National Center for Advancing Translational Sciences [NCATS] of the NIH). Dr. Silvestry has received research support from Thoratec Corporation; and is a consultant for Thoratec Corporation and HeartWare Inc. Dr. Ewald has received consulting fees from Thoratec Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 27, 2014.
- Accepted November 25, 2014.
- American College of Cardiology Foundation