Lack of improvement in quality of life after cardiac resynchronization therapy is a potent determinant of unfavorable outcomes independently from functional and echocardiographic response
Bibliographic record
Abstract
Background: Cardiac resynchronization therapy is highly effective in improving many objective and subjective indices in a subgroup of Heart Failure (HF) patients. The prognostic impact of improvement in Quality of Life (QoL) due to CRT has never been evaluated. Aim of the study: We aimed at assessing if range of QoL improvement after pacing influences future outcomes in CRT patients. Material and methods: Patients participating in TRUST CRT randomized trial, with HF in NYHA class III-IV, QRS width ≥120ms, left ventricular ejection fraction ≤35% and significant mechanical dyssynchrony were included. Ninety-seven participants (21 female, median age 61, 61% ischemic) of who survived 6 months after randomization were analyzed in this substudy. All subjects fulfilled Minnesota quality of life questionnaire prior to and 6 months after CRT-D implantation. Data on Major Adverse Cardiac Events (MACE - death, HF hospitalization or heart transplant) collected within the next 1.5 year and adjudicated blindly were censoring variables. Results: Within the first 6 months of resynchronization QoL scores improved in 81%, while worsened in 19% of patients (median change 14 points, interquartile range 23). During subsequent 1.5 year MACEs occurred in 33% of patients, including 17% who died. Patients who experienced MACE had higher baseline creatinine, NT-proBNP levels, greater left atrium, severity of mitral regurgitation and were taking more often Digoxin. Subjects without QoL improvement were significantly (both P<0.05) more prone to experience MACE (61 vs. 26%) and to die (44 vs. 11%) within follow-up. After adjusting for both baseline differences and changes due to CRT (reduction in functional class and in left ventricular end-systolic volume index), lack of QoL improvement increased probability of future MACE by 2.7-times (95% CI 1.25-5.99; P=0.01) and of death by 3.4-times (95% CI 1.2-9.5; P=0.02). This effect was independent from clinical and echocardiographic response. Conclusions: Lack of improvement in quality of life after CRT is strongly associated with unfavorable prognosis, this effect is independent from functional or echocardiographic response.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".