WEBB FELLOW: National Survey of Treatment Decision-making in Recurrent Infective Endocarditis Due to Intravenous Drug Use

This study sought to identify predictors of transplantation/left ventricular assist device (LVAD)-free survival among patients with left ventricular nonischemic cardiomyopathy (NICM) and ventricular tachycardia (VT).Outcomes vary widely among these patients.The derivation cohort consisted of patients with NICM undergoing VT ablation from 2007 to 2011. Scar percentage was defined as the area of low voltage divided by total surface area. Cox proportional hazard modeling was performed to identify predictors of shorter time to the primary endpoint of death, transplantation, or LVAD. A risk score was created using β regression coefficients. The risk score was then validated in a separate cohort of patients undergoing ablation from 2004 to 2007.Of 100 patients with NICM undergoing VT ablation, 41 experienced an endpoint during 1.2 years mean follow-up. In multivariate modeling, VT storm, wider native QRS duration, greater endocardial/epicardial bipolar scar percentage, and lower left ventricular ejection fraction (LVEF) identified worse transplantation/LVAD-free survival. The risk score = (VT storm × 83) + (greater of endocardial/epicardial bipolar scar percentage × 4) + (QRS duration) − (LVEF × 3). A score >180 identified patients at high risk for the endpoint, whereas a score <100 identified low risk. Among the 50-patient validation cohort, the high-risk group again had worse transplantation/LVAD-free survival during a mean 3.0 years of follow-up (<10% vs. 50% for intermediate and >80% for low, p < 0.001).Wider native QRS duration, greater bipolar scar percentage, VT storm, and lower LVEF are potent predictors of time to death, transplantation, or LVAD. By combining these variables into an “electrophysiological risk score,” patient risk can be refined.