Traditionally, organ dysfunction is evaluated in isolation, meanwhile in clinical settings, several organs may be caused, which can be a marker of more severe HF. Low cardiac output and systemic venous congestion due to advanced HF are known to cause multiple organ dysfunction or tissue damage, which leads to disease progression and adverse outcomes. Therefore, risk stratification of potential CRT candidates on the basis of pre‐implantation assessment remains important. However, individual outcomes in CRT recipients vary significantly, and long‐term death rates remain high.Ĭertain patients, such as those with ischaemic cardiomyopathy, severely dilated ventricles, or right ventricular (RV) dysfunction, have been reported to derive less survival benefit than expected from CRT. A higher MELD‐XI score was associated with a greater risk of all‐cause mortality than a lower MELD‐XI score regardless of whether a pacemaker or defibrillator was implanted (log‐rank test: P = 0.010 and P < 0.001, respectively).Ĭardiac resynchronization therapy (CRT) is an established treatment for patients who have advanced‐stage heart failure (HF) with a reduced left ventricular ejection fraction (LVEF) and wide QRS complex. Even after adjustment for clinically relevant factors and a conventional risk score, the MELD‐XI score was still associated with mortality (adjusted hazard ratio: 1.04, 95% confidence interval: 1.00–1.07, P = 0.014, and adjusted hazard ratio: 1.04, 95% confidence interval: 1.01–1.09, P = 0.005, respectively). Kaplan–Meier analysis revealed that patients with a higher MELD‐XI score had a greater risk of all‐cause mortality (log‐rank test: P < 0.001). During a median follow‐up of 30 months (inter‐quartile range, 9–67), 105 patients (37.1%) died. The functional CRT response rate was also significantly lower in the third tertile group ( P = 0.011). Compared with the other groups, the third tertile group exhibited significantly older age, higher prevalence of diabetes mellitus and hypertension, lower haemoglobin level, and higher N‐terminal pro‐brain natriuretic peptide level (all P < 0.05). The primary endpoint was all‐cause mortality. Patients were divided into three groups based on tertiles of the MELD‐XI score: first tertile (MELD‐XI = 9.44, n = 95), second tertile (9.44 < MELD‐XI < 13.4, n = 94), and third tertile (MELD‐XI ≥ 13.4, n = 94). Blood samples were collected before CRT implantation. Clinical records of 283 patients who underwent CRT implantation between March 2003 and October 2020 were retrospectively evaluated (mean age 67 ± 12, 22.6% female).
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