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Title: The MADIT-ICD benefit score helps to select implantable cardioverter-defibrillator candidates in cardiac resynchronization therapy
Authors: DAUW, Jeroen 
Martens, Pieter
NIJST, Petra 
MEEKERS, Evelyne 
DEFERM, Sebastien 
GRUWEZ, Henri 
Rivero-Ayerza, Maximo
Van Herendael, Hugo
PISON, Laurent 
NUYENS, Dieter 
DUPONT, Matthias 
MULLENS, Wilfried 
Issue Date: 2022
Source: EUROPACE, MAR 2022
Status: Early view
Abstract: Aims The aim of this study is to evaluate whether the MADIT-ICD benefit score can predict who benefits most from the addition of implantable cardioverter-defibrillator (ICD) to cardiac resynchronization therapy (CRT) in real-world patients with heart failure with reduced ejection fraction (HFrEF) and to compare this with selection according to a multidisciplinary expert centre approach. Methods and results Consecutive HFrEF patients who received a CRT for a guideline indication at a tertiary care hospital (Ziekenhuis Oost-Limburg, Genk, Belgium) between October 2008 and September 2016, were retrospectively evaluated. The MADIT-ICD benefit groups (low, intermediate, and high) were compared with the current multidisciplinary expert centre approach. Endpoints were (i) sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and (ii) non-arrhythmic mortality. Of the 475 included patients, 165 (34.7%) were in the lowest, 220 (46.3%) in the intermediate, and 90 (19.0%) in the highest benefit group. After a median follow-up of 34 months, VT/VF occurred in 3 (1.8%) patients in the lowest, 9 (4.1%) in the intermediate, and 13 (14.4%) in the highest benefit group (P < 0.001). Vice versa, non-arrhythmic death occurred in 32 (19.4%) in the lowest, 32 (14.6%) in the intermediate, and 3 (3.3%) in the highest benefit group (P = 0.002). The predictive power for ICD benefit was comparable between expert multidisciplinary judgement and the MADIT-ICD benefit score: Uno's C-statistic 0.69 vs. 0.69 (P = 0.936) for VT/VF and 0.62 vs. 0.60 (P = 0.790) for non-arrhythmic mortality. Conclusion The MADIT-ICD benefit score can identify who benefits most from CRT-D and is comparable with multidisciplinary judgement in a CRT expert centre.
Notes: Mullens, W (corresponding author), Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium.
Keywords: Heart failure; Implantable cardioverter-defibrillator; Cardiac;resynchronization therapy; Patient selection; MADIT-ICD benefit score
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ISSN: 1099-5129
e-ISSN: 1532-2092
DOI: 10.1093/europace/euac039
ISI #: WOS:000784737700001
Category: A1
Type: Journal Contribution
Appears in Collections:Research publications

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