Heart Rhythm O2 · Mar 6, 2026

Survival prediction after cardiac resynchronization therapy: Clinical scores vs left ventricular ejection fraction

By Demian J, Paul A, Tang WHW et al.

BACKGROUND: Left ventricular ejection fraction (LVEF) is commonly used to characterize remodeling and estimate prognosis after cardiac resynchronization therapy (CRT). Clinical scores assessed at follow-up may provide complementary prognostic information. OBJECTIVE: This study compared the predictive value of LVEF and clinical scores, measured at 6 months after CRT, for long-term survival. METHODS: This prospective cohort study enrolled 528 patients undergoing CRT between May 2016 and June 2022. Clinical scores, including the 6-minute walk distance, gait speed, the timed up-and-go test, the Study of Osteoporotic Fractures frailty index, and the 5-level EuroQol-5 dimension score, were evaluated at 6 months after CRT alongside LVEF. The primary end point was event-free survival, defined as survival without left ventricular assist device implantation, heart transplantation, or death. Using a nested model approach, Cox proportional hazards models assessed predictive accuracy using the concordance index (C-index). RESULTS: Over a mean follow-up of 3.73 years, 127 patients (24%) reached the primary end point. In models adjusted for baseline covariates, LVEF at 6 months was associated with event-free survival (C-index 0.732), whereas several clinical scores showed higher discrimination (C-index: 6-minute walk distance 0.767; Study of Osteoporotic Fractures frailty index 0.754; timed up-and-go test 0.749; 5-level EuroQol-5-dimension score 0.740). Findings were consistent when using clinically relevant cut points. In LVEF-adjusted models, high-performing clinical measures provided incremental prognostic value beyond LVEF. CONCLUSION: Although LVEF remains a valuable metric, a multidimensional approach incorporating clinical scores alongside LVEF may improve long-term survival prediction after CRT. Their integration into clinical practice could enhance personalized care and risk stratification for CRT recipients.

doi.org/10.1016/j.hroo.2026.02.023Open accessPubMed 42369788Biomarkers