The MUSIC Risk score: a simple method for predicting mortality in ambulatory patients with chronic heart failure

Vázquez, Rafael; Bayés-Genís, A; Cygankiewicz, Iwona; Pascual-Figal, Domingo A.; Grigorian-Shamagian, Lilián; Pavón, Ricardo; González-Juanàtey, José Ramón; Cubero, José M.; Pastor, Luis; Ordóñez-Llanos, Jordi; Cinca, Juan; Luna, Antoni Bayés de

doi:10.1093/eurheartj/ehp032

Cited by 208 publications

(187 citation statements)

References 32 publications

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“…The study population included 651 consecutive patients with symptomatic CHF corresponding to NYHA classes II and III enrolled in the MUSIC study, a prospective, multicenter study designed to assess risk predictors for cardiovascular mortality in ambulatory patients with CHF [6]. A two-or three-lead 24-hour Holter ECG sampled at 200 Hz was recorded in each patient at enrolment using ELA Medical equipment (Sorin Group, Paris, France).…”

Section: Methodsmentioning

confidence: 99%

T-wave Morphology Restitution Dependency with Heart Rate Range and Its Association with Sudden Cardiac Death in Chronic Heart Failure

Ramírez

Orini

Pueyo

et al. 2017

Computing in Cardiology Conference (CinC)

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The index of T-wave morphology restitution (TMR) has recently been presented as a sudden cardiac death (SCD) predictor in a population of chronic heart failure (CHF) patients. This index quantifies the level of variation in the T-wave morphology per RR interval (RRI) increment. The impact of using different definitions of ranges of RRI (∆RRI) and the study of the interaction between TMR and ∆RRI are relevant for both the optimization and the mechanistic interpretation of the index. This study aims to investigate the interaction between ∆RRI and TMR and to assess whether different definitions of ∆RRI (patientsindependent or patient-specific) may affect the predictive value of TMR. Holter ECG recordings from 651 patients with CHF, including SCD, victims of other causes and survivors, were analyzed. Mann-Whitney test was used to evaluate significant differences between SCD victims and the rest of patients. In the patient-independent analysis, TMR values only showed significant differences when 0.25s≤ ∆RR≤0.3s, while in the patient-specific analysis TMR values were significantly different when ∆RR≥0.6 of the maximum RR range, ∆RR max . In conclusion, the index TMR is a predictor of SCD robust to variations in ∆RR values evaluated in segments comprising at least 0.6 of ∆RR max . IntroductionThe action potential duration (APD) restitution (APDR) curve represents the interaction between local APD and local cycle length [1]. The morphology of the T-wave reflects the distribution of the repolarization sequence along the ventricle [2][3][4]. Therefore, the spatio-temporal inhomogeneity of the ventricular repolarization process as a response to changes in heart rate may be captured by an index measuring T-wave morphological changes.In a recent study, the index of T-wave morphology restitution (TMR) was proposed and proved to predict sudden cardiac death (SCD) in a population of 651 chronic heart failure (CHF) patients [5]. The TMR is calculated as the difference in the morphology of two T-waves measured at two RR intervals (RRI) defining the maximum intrasubject RRI range, ∆RRI, and normalized by ∆RRI. The impact of using different definitions of ∆RRI and the study of the interaction between TMR and ∆RRI are relevant for both the optimization and the mechanistic interpretation of the index. This study aims to investigate the interaction between ∆RRI and TMR and to assess whether different definitions of ∆RRI may affect the predictive value of TMR.In this study we calculated the evolution of the index TMR with an patient-independent and patient-specific change in ∆RR. Then, we calculated the SCD predictive value of TMR at each value of ∆RR and we compared the patient-independent and patient-specific results. 2.Materials and Methods MaterialsThe study population included 651 consecutive patients with symptomatic CHF corresponding to NYHA classes II and III enrolled in the MUSIC study, a prospective, multicenter study designed to assess risk predictors for cardiovascular mortality in ambulatory patients with CHF [6]. ...

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Section: Methodsmentioning

confidence: 99%

T-wave Morphology Restitution Dependency with Heart Rate Range and Its Association with Sudden Cardiac Death in Chronic Heart Failure

Ramírez

Orini

Pueyo

et al. 2017

Computing in Cardiology Conference (CinC)

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“…12 We focused on validated predictors of mortality in community-dwelling adults who were older adults [13][14][15] or had heart failure. [16][17][18][19] Predictors of the benefit outcome were age (years), gender, smoking status (never, ever, and current), history of diabetes mellitus, left ventricular ejection fraction (continuous), cardiothoracic ratio (continuous), pulse (b min À1 ), diuretic use, serum creatinine (mg/dl), serum sodium (mg/dl), history of chronic obstructive pulmonary disease, and history of stroke. Additional predictors of the harm outcome were presence of dependent edema, pulmonary edema, or crackles; weight (kg); systolic blood pressure (mm Hg); and diastolic blood pressure (mm Hg).…”

Section: Analytic Methodsmentioning

confidence: 99%

Assessing the applicability of trial evidence to a target sample in the presence of heterogeneity of treatment effect

Weiss

Segal

Varadhan

2012

Pharmacoepidemiology and Drug

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Purpose To propose methods for the quantitative assessment of the applicability of evidence from a trial to a target sample using individual data. Methods Demonstration was with a trial of drug therapy to prevent mortality and an accompanying registry of people with heart failure. Principal components analysis with biplots did not identify measurement discrepancies. Multiple imputation with chained equations addressed missing predictor values. A proportional hazards model with interaction term, including graphical interpretation and a multivariate interaction test, identified heterogeneity of treatment effect. An interval of homogeneity of treatment effect was the interval of the baseline risk of outcome in which no two treatment effects were statistically significantly different. Absolute risk reduction for individuals was estimated for both benefit and harm outcomes and presented in a bivariate treatment effects scatterplot. Results Overall, the trial evidence applied to most of the registry according to overlapping distributions of estimated benefit and harm. However, 52% of trial and 33% of registry participants were estimated to have net benefit, and 14% of trial and 36% of registry participants were estimated to have strong net harmful treatment effect, that is, the individual estimate of harm was more than twice the estimate of benefit. Conclusions The proposed methods provide quantitative assessment of the applicability of trial evidence to a target sample. They combine the strengths of different study designs, namely, unbiased effects estimation from trials and representation in observational studies, while addressing the practical challenges of combining information, namely, measurement discrepancies and missing data.

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“…According to the statistical results, it seems that the most powerful indicators of 1-year mortality in our group are hyponatraemia and intravenous therapy. Hyponatraemia is generally considered a predictor of non-favourable prognosis in HF patients [14][15][16][17][18] . Intravenous therapy comprised the administration of diuretic agents and/or inotropy.…”

Section: One-year Mortality Predictorsmentioning

confidence: 99%

Ten-year survival and prognostic markers in one thousand patients with advanced heart failure. A single-centre analysis

Lesny¹,

Luknar²,

Matějka³

et al. 2016

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim. Patients with advanced heart failure (HF) represent a pool of candidates for heart transplantation and long-term mechanical circulatory support devices. The aim of our study was to determine simple and reliable markers of one-year mortality for selection of the most suitable patients for heart replacement therapy. Methods and Results. One thousand consecutive patients with HF (mean age 49 ± 10.9 years; 86.8% males) referred to a single tertiary centre from January 1998 to January 2010 in order to assess the indication for heart transplantation were enrolled. Kaplan-Meier survival analysis was performed. Independent mortality predictors were established using logistic regression analysis. The mean follow-up was 4.3 ± 2.7 years (range 1-12 years). Cumulative survival was as follows: 1-year survival 83%, 3-year 63%, 5-year 50%, 7-year 39%, and 10-year 23%. Independent predictors of 1-year mortality included coronary artery disease, left ventricular diastolic diameter >79 mm, plasma sodium <135 mmol/L, the need for intravenous treatment at hospital admission (diuretics and/or inotropes), and furosemide dose at discharge >240 mg/day. Conclusions. Short-term prognosis of HF patient can be estimated based on simple parameters. Patients with signs of poor prognosis should be referred to tertiary centres to be considered for heart replacement therapy.

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The MUSIC Risk score: a simple method for predicting mortality in ambulatory patients with chronic heart failure

Abstract: A simple score with a limited number of non-invasive variables successfully predicted cardiac mortality in a real-life cohort of CHF patients. The use of this model in clinical practice identifies a subgroup of high-risk patients that should be closely managed.

Cited by 208 publications

References 32 publications

T-wave Morphology Restitution Dependency with Heart Rate Range and Its Association with Sudden Cardiac Death in Chronic Heart Failure

T-wave Morphology Restitution Dependency with Heart Rate Range and Its Association with Sudden Cardiac Death in Chronic Heart Failure

Assessing the applicability of trial evidence to a target sample in the presence of heterogeneity of treatment effect

Ten-year survival and prognostic markers in one thousand patients with advanced heart failure. A single-centre analysis

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