Score of Perez-Rodon et al for Predicting the Absence of Left Ventricular Remodeling Prior to Insertion of an Implantable Cardioverter Defibrillator (ICD)
Placement of an implantable cardioverter defibrillator (ICD) is often delayed while waiting to see of optimal drug therapy can reverse damage to the left ventricle. Perez-Rodon et al report a score for identifying a patient who is unlikely to have left ventricular remodeling while waiting and who should be considered for prophylactic placement of the ICD. The authors are from Hospital Universitari Vall d'Hebron and Universitat Autonoma de Barcelona in Spain.
Patient selection: heart failure with LVEF <= 35%
Normally an ICD is implanted after waiting 3-6 months while receiving optimal drug therapy. This is intended to give a chance for the left ventricle to remodel and for LVEF to improve. However, some patients do not show improvement.
Parameters:
(1) diagnosis
(2) heart failure duration in months
(3) left ventricular end-diastolic diameter index in mm per square meter (diameter divided by body surface area)
Parameter
Finding
Points
diagnosis
ischemic cardiomyopathy
4
other
0
heart failure duration
< 12 months
0
12 to 60 months
5
> 60 months
7
LVEDDL
< 33 mm per square m
0
33 to 38
4
> 38 mm per square m
5
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 16
• The higher the score the greater the likelihood that left ventricular remodeling will not occur.
• A patient with a high score may benefit from placement of a prophylactic ICD.
Score
Risk Group
Absence of LV Remodeling
0 to 4
low
24%
5 to 9
intermediate
63%
10 to 16
high
90%
Performance:
• The area under the ROC curve is 0.81.
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