ORIGINAL RESEARCH ARTICLE
ORIGINAL RESEARCH ARTICLE
Derivation and Validation of a Novel RightSided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices The EUROMACS (European Registry for Patients with Mechanical Circulatory Support) Right-Sided Heart Failure Risk Score Editorial, see p XXX Downloaded from http://circ.ahajournals.org/ by guest on August 28, 2017
BACKGROUND: The aim of the study was to derive and validate a novel risk score for early right-sided heart failure (RHF) after left ventricular assist device implantation. METHODS: The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) was used to identify adult patients undergoing continuous-flow left ventricular assist device implantation with mainstream devices. Eligible patients (n=2988) were randomly divided into derivation (n=2000) and validation (n=988) cohorts. The primary outcome was early (7 >7.5 >9.5
Sensitivity 100.00 92.74 87.90 72.58 72.58 44.35 37.90 34.68 20.16 8.06 7.26 7.26 4.84 0.81 0.00
95% CI 97.1 - 100.0 86.7 - 96.6 80.8 - 93.1 63.8 - 80.2 63.8 - 80.2 35.4 - 53.5 29.3 - 47.1 26.4 - 43.7 13.5 - 28.3 3.9 - 14.3 3.4 - 13.3 3.4 - 13.3 1.8 - 10.2 0.02 - 4.4 0.0 - 2.9
Specificity 0.00 21.15 31.36 71.30 71.45 89.64 92.31 93.20 96.30 98.22 98.22 98.52 98.67 99.70 100.00
95% CI 0.0 - 0.5 18.1 - 24.4 27.9 - 35.0 67.7 - 74.7 67.9 - 74.8 87.1 - 91.8 90.0 - 94.2 91.0 - 95.0 94.6 - 97.6 96.9 - 99.1 96.9 - 99.1 97.3 - 99.3 97.5 - 99.4 98.9 - 100.0 99.5 - 100.0
+LR 1.00 1.18 1.28 2.53 2.54 4.28 4.93 5.10 5.45 4.54 4.09 4.91 3.63 2.73
95% CI
-LR
1.0 - 1.4 1.1 - 1.5 2.2 - 2.8 2.3 - 2.9 3.5 - 5.2 3.9 - 6.2 4.0 - 6.5 3.8 - 7.7 2.5 - 8.2 2.2 - 7.7 2.6 - 9.2 1.7 - 7.9 0.4 - 19.2
0.34 0.39 0.38 0.38 0.62 0.67 0.70 0.83 0.94 0.94 0.94 0.96 0.99 1.00
95% CI 0.2 0.2 0.3 0.3 0.5 0.5 0.5 0.6 0.5 0.5 0.5 0.5 0.2
-
0.6 0.6 0.5 0.5 0.8 0.9 1.0 1.2 1.6 1.7 1.7 1.8 4.0
+PV 15.5 17.7 19.0 31.7 31.8 44.0 47.5 48.3 50.0 45.5 42.9 47.4 40.0 33.3
95% CI 13.1 - 18.2 14.9 - 20.9 15.9 - 22.5 26.3 - 37.4 26.4 - 37.6 35.1 - 53.2 37.3 - 57.8 37.6 - 59.2 35.5 - 64.5 23.9 - 68.3 21.3 - 66.6 23.9 - 71.8 16.3 - 67.7 0.8 - 90.6
-PV 94.1 93.4 93.4 93.4 89.8 89.0 88.6 86.8 85.3 85.2 85.3 85.0 84.6 84.5
95% CI 89.1 89.3 90.9 90.9 87.2 86.5 86.0 84.2 82.7 82.5 82.6 82.3 81.9 81.8
-
97.3 96.3 95.4 95.4 92.0 91.2 90.8 89.1 87.8 87.7 87.7 87.4 87.0 86.9
6
Soliman O.I.I. et al. EUROMACS-RHF Risk Score
Supplementary Table VI. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive value according to the EUROMACS-RHF risk score in the HeartWare subgroup in the derivation cohort. Criterion >=0 >0 >1 >2 >2.5 >3 * >4 >4.5 >5 >5.5 >6 >6.5 >7 >7.5 >8.5 >9.5
Sensitivity 100.00 94.65 92.18 77.78 77.78 50.21 45.68 42.80 26.75 17.28 16.46 14.40 11.52 0.82 0.82 0.00
95% CI 98.5 - 100.0 91.0 - 97.1 88.1 - 95.2 72.0 - 82.8 72.0 - 82.8 43.7 - 56.7 39.3 - 52.2 36.5 - 49.3 21.3 - 32.8 12.7 - 22.6 12.0 - 21.7 10.2 - 19.5 7.8 - 16.2 0.10 - 2.9 0.10 - 2.9 0.0 - 1.5
Specificity 0.00 15.84 25.65 45.03 45.16 73.04 76.83 79.19 87.30 94.90 95.03 95.42 96.47 99.74 99.87 100.00
95% CI 0.0 - 0.5 13.3 - 18.6 22.6 - 28.9 41.5 - 48.6 41.6 - 48.8 69.7 - 76.2 73.7 - 79.8 76.1 - 82.0 84.7 - 89.6 93.1 - 96.3 93.2 - 96.5 93.7 - 96.8 94.9 - 97.7 99.1 - 100.0 99.3 - 100.0 99.5 - 100.0
+LR 1.00 1.12 1.24 1.41 1.42 1.86 1.97 2.06 2.11 3.39 3.31 3.14 3.26 3.14 6.29
95% CI
-LR
1.0 - 1.3 1.1 - 1.4 1.3 - 1.6 1.3 - 1.6 1.6 - 2.1 1.7 - 2.3 1.8 - 2.4 1.7 - 2.6 2.6 - 4.5 2.5 - 4.4 2.3 - 4.3 2.3 - 4.6 0.8 - 12.5 1.6 - 25.0
0.34 0.30 0.49 0.49 0.68 0.71 0.72 0.84 0.87 0.88 0.90 0.92 0.99 0.99 1.00
95% CI 0.2 0.2 0.4 0.4 0.6 0.6 0.6 0.7 0.6 0.6 0.6 0.6 0.2 0.1
-
0.6 0.5 0.6 0.6 0.8 0.8 0.9 1.0 1.2 1.2 1.2 1.3 4.0 7.0
+PV 24.1 26.3 28.3 31.0 31.1 37.2 38.5 39.5 40.1 51.9 51.3 50.0 50.9 50.0 66.7
95% CI 21.5 - 26.9 23.5 - 29.4 25.2 - 31.6 27.4 - 34.9 27.4 - 34.9 31.9 - 42.7 32.9 - 44.4 33.6 - 45.7 32.5 - 48.1 40.5 - 63.1 39.6 - 62.8 37.7 - 62.3 37.1 - 64.6 3.9 - 96.1 9.4 - 99.2
-PV 90.3 91.2 86.4 86.5 82.2 81.6 81.3 78.9 78.3 78.1 77.8 77.4 76.0 76.0 75.9
95% CI 84.0 86.5 82.7 82.7 79.1 78.6 78.3 76.0 75.5 75.4 75.0 74.6 73.2 73.2 73.1
-
94.7 94.6 89.6 89.7 85.0 84.4 84.1 81.6 80.9 80.8 80.4 80.0 78.6 78.6 78.5
7
Soliman O.I.I. et al. EUROMACS-RHF Risk Score
Supplementary Table VII. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive value according to the EUROMACS-RHF risk score in the HeartMate 3 subgroup in the derivation cohort.
Criterion >=0 >0 >1 >2 >3 * >4 >5 >5.5 >6 >7 >7.5
Sensitivity 100.00 83.33 76.19 61.90 35.71 26.19 16.67 9.52 7.14 0.00 0.00
95% CI 91.6 - 100.0 68.6 - 93.0 60.5 - 87.9 45.6 - 76.4 21.6 - 52.0 13.9 - 42.0 7.0 - 31.4 2.7 - 22.6 1.5 - 19.5 0.0 - 8.4 0.0 - 8.4
Specificity 0.00 20.47 24.41 55.12 85.04 88.98 97.64 97.64 99.21 99.21 100.00
95% CI 0.0 - 2.9 13.8 - 28.5 17.2 - 32.8 46.0 - 63.9 77.6 - 90.7 82.2 - 93.8 93.3 - 99.5 93.3 - 99.5 95.7 - 100.0 95.7 - 100.0 97.1 - 100.0
+LR 1.00 1.05 1.01 1.38 2.39 2.38 7.06 4.03 9.07 0.00
95% CI
-LR
0.7 - 1.5 0.7 - 1.4 1.0 - 1.8 1.6 - 3.6 1.4 - 4.0 3.6 - 13.9 1.6 - 10.2 3.0 - 27.0
0.81 0.98 0.69 0.76 0.83 0.85 0.93 0.94 1.01 1.00
95% CI 0.4 0.6 0.4 0.5 0.5 0.3 0.3 0.1 0.1
-
1.6 1.7 1.1 1.2 1.4 2.6 2.8 6.6 7.1
+PV 24.9 25.7 25.0 31.3 44.1 44.0 70.0 57.1 75.0 0.0
95% CI 18.5 - 32.1 18.6 - 33.9 17.8 - 33.4 21.6 - 42.4 26.9 - 62.4 24.4 - 65.1 32.8 - 94.1 15.9 - 91.8 13.2 - 99.8 0.0 - 50.0
-PV 78.8 75.6 81.4 80.0 78.5 78.0 76.5 76.4 75.0 75.1
95% CI 60.8 59.7 71.6 72.3 70.9 70.7 69.3 69.1 67.7 67.9
-
91.2 87.6 89.0 86.4 84.9 84.2 82.8 82.6 81.3 81.5
8
Soliman O.I.I. et al. EUROMACS-RHF Risk Score
Supplemental Figures Supplementary Figure I. Components of Right Heart Failure Definition in the derivation (left) versus validation (Right) cohort. Of note, total patients who had right heart failure = 433; some patients were already on inotropic support >14 days and received later an RVAD.
9
Soliman O.I.I. et al. EUROMACS-RHF Risk Score
Supplementary Figure II. ROC Curve analysis derived from the derivation cohort (DC) and validation cohort (VC). ROC Curve of the EUROMACS RHF-Risk Score, postoperative modified (plus CPB time) EUROMACS RHF-Risk Score are compared with two published RHF risk scores derived from patients with continuous flow LVAD as well as the areas under the receiver operating characteristic (ROC) curve for the individual scores.
10
Soliman O.I.I. et al. EUROMACS-RHF Risk Score
Supplementary Figure III. Percentage of Patients Receiving Inotropic Support in derivation cohort
11
Soliman O.I.I. et al. EUROMACS-RHF Risk Score
Figure Legends Supplementary Figure I. Components of Right Heart Failure Definition in the derivation (left) versus validation (Right) cohort. Of note, total patients who had right heart failure = 433; some patients were already on inotropic support >14 days and received later an RVAD.
Supplementary Figure II. ROC Curve analysis derived from the derivation cohort (DC) and validation cohort (VC). ROC Curve of the EUROMACS RHF-Risk Score, postoperative modified (plus CPB time) EUROMACS RHF-Risk Score are compared with two published RHF risk scores derived from patients with continuous flow LVAD as well as the areas under the receiver operating characteristic (ROC) curve for the individual scores.
Supplementary Figure III. Percentage of Patients Receiving Inotropic Support in derivation cohort
12
Soliman O.I.I. et al. EUROMACS-RHF Risk Score
Appendix I. List of EUROMACS sites and investigators (alphabetical according to country) Name Universitätskliniken Innsbruck Central Clinic Hospital National Institute "Cardiology" Onze Lieve Vrouwenziekenhuis Universitair Ziekenhuis Gent Katholieke Universiteit Leuven IKEM (Institute for Experimental Cardiac Surgery) Center for Cardiovascular and Transplant Surgery Rigshospitalet Copenhagen Centre Chirurgical Marie Lannelongue Deutsches Herzzentrum Berlin Universitätsklinikum Schleswig Holstein Herz- und Diabeteszentrum NordrheinWestfalen Universitätsklinikum Eppendorf Universitäts Herzzentrum Freiburg - Bad Krozingen Klinikum Karlsburg Aristotle University of Thessaloniki Onassis Cardiac Surgery Center Heart Center of the Semmelweis University Gottsegen Gy. Hungarian Institute of Cardiology Osepdale S. Orsola Ospedale San Camillo Ospedale Niguarda Ca'Granda Ospedale Papa Giovanni XXIII Ospedale dei Colli ISMETT (Mediterranean Institute for Transplantation and Advanced Specialised Therapies) Regina Margherita Children's Hospital National Research Cardiac Surgery Center - Kazakhstan Erasmus Medisch Centrum Universitair Medisch Centrum Utrecht (UMCU) Universitair Medisch Centrum Groningen (UMCG) Rikshospitalet Childrens Memorial Hospital Silesian Center for Heart Diseases Clínica Universidad de Navarra Inselspital Bern Kinderspital Zürich Ege University School of Medicine Florence Nightingale Hospital Başkent University Hospital Yüksek Ihtisas Hospital
City: Innsbruck Baku Minsk Aalst Gent Leuven Prague
Country: Austria Azerbaijan Belarus Belgium Belgium Belgium Czech Republic
Representative Prof. Herwig Antretter Prof. Kamran Musayev Dr. Valeriya Krachak Dr. Marc Vanderheyden Prof. Yves van Belleghem Prof. Bart Meyns Prof. Ivan Netuka
Brno
Czech Republic
Prof. Petr Nemec
Copenhagen Le PlessisRobinson Berlin Lübeck Bad Oeynhausen Hamburg Freiburg
Denmark France
Prof. Finn Gustafsson Prof. Julien Guihaire
Germany Germany Germany
Prof. Thomas Krabatsch Prof. Stefan Klotz Prof. Jan Gummert
Germany Germany
Prof. Hermann Reichenspurner Prof. Friedhelm Beyersdorf
Karlsburg Thessaloniki Athens Budapest
Germany Greece Greece Hungary
Dr. Lutz Hilker Prof. Kyriakos Anastasiadis Prof. George Stavridis Prof. Béla Merkely
Budapest
Hungary
Dr. Gabor Bodor
Bologna Rome Milan Bergamo Naples Palermo
Italy Italy Italy Italy Italy Italy
Prof. Roberto Di Bartolomeo Prof. Francesco Musumeci Prof. Claudio Russo Dr. Attilio Iacovoni Dr. Cristiano Amarelli Prof. Sergio Sciacca
Torino Astana
Italy Kazakhstan
Prof. Carlo Pace Napoleone Prof. Yuri Pya
Rotterdam Utrecht
Netherlands Netherlands
Dr. Kadir Caliskan Dr. Faiz Ramjankhan
Groningen
Netherlands
Dr. Kevin Damman
Oslo Warsaw Zabrze Pamplona Bern Zürich Izmir Istanbul Ankara Ankara
Norway Poland Poland Spain Switzerland Switzerland Türkiye Türkiye Türkiye Türkiye
Prof. Arnt Fiane Prof. Bodan Maruszewski Prof. Marian Zembala Prof. Gregorio Rábago Prof. Paul Mohacsi Prof. Michael Hübler Prof. Mustafa Özbaran Dr. Erman Pektok Prof. Atilla Sezgin Prof. Ümit Kervan
13
ORIGINAL RESEARCH ARTICLE
Derivation and Validation of a Novel RightSided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices The EUROMACS (European Registry for Patients with Mechanical Circulatory Support) Right-Sided Heart Failure Risk Score Editorial, see p XXX Downloaded from http://circ.ahajournals.org/ by guest on August 28, 2017
BACKGROUND: The aim of the study was to derive and validate a novel risk score for early right-sided heart failure (RHF) after left ventricular assist device implantation. METHODS: The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) was used to identify adult patients undergoing continuous-flow left ventricular assist device implantation with mainstream devices. Eligible patients (n=2988) were randomly divided into derivation (n=2000) and validation (n=988) cohorts. The primary outcome was early (7 >7.5 >9.5
Sensitivity 100.00 92.74 87.90 72.58 72.58 44.35 37.90 34.68 20.16 8.06 7.26 7.26 4.84 0.81 0.00
95% CI 97.1 - 100.0 86.7 - 96.6 80.8 - 93.1 63.8 - 80.2 63.8 - 80.2 35.4 - 53.5 29.3 - 47.1 26.4 - 43.7 13.5 - 28.3 3.9 - 14.3 3.4 - 13.3 3.4 - 13.3 1.8 - 10.2 0.02 - 4.4 0.0 - 2.9
Specificity 0.00 21.15 31.36 71.30 71.45 89.64 92.31 93.20 96.30 98.22 98.22 98.52 98.67 99.70 100.00
95% CI 0.0 - 0.5 18.1 - 24.4 27.9 - 35.0 67.7 - 74.7 67.9 - 74.8 87.1 - 91.8 90.0 - 94.2 91.0 - 95.0 94.6 - 97.6 96.9 - 99.1 96.9 - 99.1 97.3 - 99.3 97.5 - 99.4 98.9 - 100.0 99.5 - 100.0
+LR 1.00 1.18 1.28 2.53 2.54 4.28 4.93 5.10 5.45 4.54 4.09 4.91 3.63 2.73
95% CI
-LR
1.0 - 1.4 1.1 - 1.5 2.2 - 2.8 2.3 - 2.9 3.5 - 5.2 3.9 - 6.2 4.0 - 6.5 3.8 - 7.7 2.5 - 8.2 2.2 - 7.7 2.6 - 9.2 1.7 - 7.9 0.4 - 19.2
0.34 0.39 0.38 0.38 0.62 0.67 0.70 0.83 0.94 0.94 0.94 0.96 0.99 1.00
95% CI 0.2 0.2 0.3 0.3 0.5 0.5 0.5 0.6 0.5 0.5 0.5 0.5 0.2
-
0.6 0.6 0.5 0.5 0.8 0.9 1.0 1.2 1.6 1.7 1.7 1.8 4.0
+PV 15.5 17.7 19.0 31.7 31.8 44.0 47.5 48.3 50.0 45.5 42.9 47.4 40.0 33.3
95% CI 13.1 - 18.2 14.9 - 20.9 15.9 - 22.5 26.3 - 37.4 26.4 - 37.6 35.1 - 53.2 37.3 - 57.8 37.6 - 59.2 35.5 - 64.5 23.9 - 68.3 21.3 - 66.6 23.9 - 71.8 16.3 - 67.7 0.8 - 90.6
-PV 94.1 93.4 93.4 93.4 89.8 89.0 88.6 86.8 85.3 85.2 85.3 85.0 84.6 84.5
95% CI 89.1 89.3 90.9 90.9 87.2 86.5 86.0 84.2 82.7 82.5 82.6 82.3 81.9 81.8
-
97.3 96.3 95.4 95.4 92.0 91.2 90.8 89.1 87.8 87.7 87.7 87.4 87.0 86.9
6
Soliman O.I.I. et al. EUROMACS-RHF Risk Score
Supplementary Table VI. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive value according to the EUROMACS-RHF risk score in the HeartWare subgroup in the derivation cohort. Criterion >=0 >0 >1 >2 >2.5 >3 * >4 >4.5 >5 >5.5 >6 >6.5 >7 >7.5 >8.5 >9.5
Sensitivity 100.00 94.65 92.18 77.78 77.78 50.21 45.68 42.80 26.75 17.28 16.46 14.40 11.52 0.82 0.82 0.00
95% CI 98.5 - 100.0 91.0 - 97.1 88.1 - 95.2 72.0 - 82.8 72.0 - 82.8 43.7 - 56.7 39.3 - 52.2 36.5 - 49.3 21.3 - 32.8 12.7 - 22.6 12.0 - 21.7 10.2 - 19.5 7.8 - 16.2 0.10 - 2.9 0.10 - 2.9 0.0 - 1.5
Specificity 0.00 15.84 25.65 45.03 45.16 73.04 76.83 79.19 87.30 94.90 95.03 95.42 96.47 99.74 99.87 100.00
95% CI 0.0 - 0.5 13.3 - 18.6 22.6 - 28.9 41.5 - 48.6 41.6 - 48.8 69.7 - 76.2 73.7 - 79.8 76.1 - 82.0 84.7 - 89.6 93.1 - 96.3 93.2 - 96.5 93.7 - 96.8 94.9 - 97.7 99.1 - 100.0 99.3 - 100.0 99.5 - 100.0
+LR 1.00 1.12 1.24 1.41 1.42 1.86 1.97 2.06 2.11 3.39 3.31 3.14 3.26 3.14 6.29
95% CI
-LR
1.0 - 1.3 1.1 - 1.4 1.3 - 1.6 1.3 - 1.6 1.6 - 2.1 1.7 - 2.3 1.8 - 2.4 1.7 - 2.6 2.6 - 4.5 2.5 - 4.4 2.3 - 4.3 2.3 - 4.6 0.8 - 12.5 1.6 - 25.0
0.34 0.30 0.49 0.49 0.68 0.71 0.72 0.84 0.87 0.88 0.90 0.92 0.99 0.99 1.00
95% CI 0.2 0.2 0.4 0.4 0.6 0.6 0.6 0.7 0.6 0.6 0.6 0.6 0.2 0.1
-
0.6 0.5 0.6 0.6 0.8 0.8 0.9 1.0 1.2 1.2 1.2 1.3 4.0 7.0
+PV 24.1 26.3 28.3 31.0 31.1 37.2 38.5 39.5 40.1 51.9 51.3 50.0 50.9 50.0 66.7
95% CI 21.5 - 26.9 23.5 - 29.4 25.2 - 31.6 27.4 - 34.9 27.4 - 34.9 31.9 - 42.7 32.9 - 44.4 33.6 - 45.7 32.5 - 48.1 40.5 - 63.1 39.6 - 62.8 37.7 - 62.3 37.1 - 64.6 3.9 - 96.1 9.4 - 99.2
-PV 90.3 91.2 86.4 86.5 82.2 81.6 81.3 78.9 78.3 78.1 77.8 77.4 76.0 76.0 75.9
95% CI 84.0 86.5 82.7 82.7 79.1 78.6 78.3 76.0 75.5 75.4 75.0 74.6 73.2 73.2 73.1
-
94.7 94.6 89.6 89.7 85.0 84.4 84.1 81.6 80.9 80.8 80.4 80.0 78.6 78.6 78.5
7
Soliman O.I.I. et al. EUROMACS-RHF Risk Score
Supplementary Table VII. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive value according to the EUROMACS-RHF risk score in the HeartMate 3 subgroup in the derivation cohort.
Criterion >=0 >0 >1 >2 >3 * >4 >5 >5.5 >6 >7 >7.5
Sensitivity 100.00 83.33 76.19 61.90 35.71 26.19 16.67 9.52 7.14 0.00 0.00
95% CI 91.6 - 100.0 68.6 - 93.0 60.5 - 87.9 45.6 - 76.4 21.6 - 52.0 13.9 - 42.0 7.0 - 31.4 2.7 - 22.6 1.5 - 19.5 0.0 - 8.4 0.0 - 8.4
Specificity 0.00 20.47 24.41 55.12 85.04 88.98 97.64 97.64 99.21 99.21 100.00
95% CI 0.0 - 2.9 13.8 - 28.5 17.2 - 32.8 46.0 - 63.9 77.6 - 90.7 82.2 - 93.8 93.3 - 99.5 93.3 - 99.5 95.7 - 100.0 95.7 - 100.0 97.1 - 100.0
+LR 1.00 1.05 1.01 1.38 2.39 2.38 7.06 4.03 9.07 0.00
95% CI
-LR
0.7 - 1.5 0.7 - 1.4 1.0 - 1.8 1.6 - 3.6 1.4 - 4.0 3.6 - 13.9 1.6 - 10.2 3.0 - 27.0
0.81 0.98 0.69 0.76 0.83 0.85 0.93 0.94 1.01 1.00
95% CI 0.4 0.6 0.4 0.5 0.5 0.3 0.3 0.1 0.1
-
1.6 1.7 1.1 1.2 1.4 2.6 2.8 6.6 7.1
+PV 24.9 25.7 25.0 31.3 44.1 44.0 70.0 57.1 75.0 0.0
95% CI 18.5 - 32.1 18.6 - 33.9 17.8 - 33.4 21.6 - 42.4 26.9 - 62.4 24.4 - 65.1 32.8 - 94.1 15.9 - 91.8 13.2 - 99.8 0.0 - 50.0
-PV 78.8 75.6 81.4 80.0 78.5 78.0 76.5 76.4 75.0 75.1
95% CI 60.8 59.7 71.6 72.3 70.9 70.7 69.3 69.1 67.7 67.9
-
91.2 87.6 89.0 86.4 84.9 84.2 82.8 82.6 81.3 81.5
8
Soliman O.I.I. et al. EUROMACS-RHF Risk Score
Supplemental Figures Supplementary Figure I. Components of Right Heart Failure Definition in the derivation (left) versus validation (Right) cohort. Of note, total patients who had right heart failure = 433; some patients were already on inotropic support >14 days and received later an RVAD.
9
Soliman O.I.I. et al. EUROMACS-RHF Risk Score
Supplementary Figure II. ROC Curve analysis derived from the derivation cohort (DC) and validation cohort (VC). ROC Curve of the EUROMACS RHF-Risk Score, postoperative modified (plus CPB time) EUROMACS RHF-Risk Score are compared with two published RHF risk scores derived from patients with continuous flow LVAD as well as the areas under the receiver operating characteristic (ROC) curve for the individual scores.
10
Soliman O.I.I. et al. EUROMACS-RHF Risk Score
Supplementary Figure III. Percentage of Patients Receiving Inotropic Support in derivation cohort
11
Soliman O.I.I. et al. EUROMACS-RHF Risk Score
Figure Legends Supplementary Figure I. Components of Right Heart Failure Definition in the derivation (left) versus validation (Right) cohort. Of note, total patients who had right heart failure = 433; some patients were already on inotropic support >14 days and received later an RVAD.
Supplementary Figure II. ROC Curve analysis derived from the derivation cohort (DC) and validation cohort (VC). ROC Curve of the EUROMACS RHF-Risk Score, postoperative modified (plus CPB time) EUROMACS RHF-Risk Score are compared with two published RHF risk scores derived from patients with continuous flow LVAD as well as the areas under the receiver operating characteristic (ROC) curve for the individual scores.
Supplementary Figure III. Percentage of Patients Receiving Inotropic Support in derivation cohort
12
Soliman O.I.I. et al. EUROMACS-RHF Risk Score
Appendix I. List of EUROMACS sites and investigators (alphabetical according to country) Name Universitätskliniken Innsbruck Central Clinic Hospital National Institute "Cardiology" Onze Lieve Vrouwenziekenhuis Universitair Ziekenhuis Gent Katholieke Universiteit Leuven IKEM (Institute for Experimental Cardiac Surgery) Center for Cardiovascular and Transplant Surgery Rigshospitalet Copenhagen Centre Chirurgical Marie Lannelongue Deutsches Herzzentrum Berlin Universitätsklinikum Schleswig Holstein Herz- und Diabeteszentrum NordrheinWestfalen Universitätsklinikum Eppendorf Universitäts Herzzentrum Freiburg - Bad Krozingen Klinikum Karlsburg Aristotle University of Thessaloniki Onassis Cardiac Surgery Center Heart Center of the Semmelweis University Gottsegen Gy. Hungarian Institute of Cardiology Osepdale S. Orsola Ospedale San Camillo Ospedale Niguarda Ca'Granda Ospedale Papa Giovanni XXIII Ospedale dei Colli ISMETT (Mediterranean Institute for Transplantation and Advanced Specialised Therapies) Regina Margherita Children's Hospital National Research Cardiac Surgery Center - Kazakhstan Erasmus Medisch Centrum Universitair Medisch Centrum Utrecht (UMCU) Universitair Medisch Centrum Groningen (UMCG) Rikshospitalet Childrens Memorial Hospital Silesian Center for Heart Diseases Clínica Universidad de Navarra Inselspital Bern Kinderspital Zürich Ege University School of Medicine Florence Nightingale Hospital Başkent University Hospital Yüksek Ihtisas Hospital
City: Innsbruck Baku Minsk Aalst Gent Leuven Prague
Country: Austria Azerbaijan Belarus Belgium Belgium Belgium Czech Republic
Representative Prof. Herwig Antretter Prof. Kamran Musayev Dr. Valeriya Krachak Dr. Marc Vanderheyden Prof. Yves van Belleghem Prof. Bart Meyns Prof. Ivan Netuka
Brno
Czech Republic
Prof. Petr Nemec
Copenhagen Le PlessisRobinson Berlin Lübeck Bad Oeynhausen Hamburg Freiburg
Denmark France
Prof. Finn Gustafsson Prof. Julien Guihaire
Germany Germany Germany
Prof. Thomas Krabatsch Prof. Stefan Klotz Prof. Jan Gummert
Germany Germany
Prof. Hermann Reichenspurner Prof. Friedhelm Beyersdorf
Karlsburg Thessaloniki Athens Budapest
Germany Greece Greece Hungary
Dr. Lutz Hilker Prof. Kyriakos Anastasiadis Prof. George Stavridis Prof. Béla Merkely
Budapest
Hungary
Dr. Gabor Bodor
Bologna Rome Milan Bergamo Naples Palermo
Italy Italy Italy Italy Italy Italy
Prof. Roberto Di Bartolomeo Prof. Francesco Musumeci Prof. Claudio Russo Dr. Attilio Iacovoni Dr. Cristiano Amarelli Prof. Sergio Sciacca
Torino Astana
Italy Kazakhstan
Prof. Carlo Pace Napoleone Prof. Yuri Pya
Rotterdam Utrecht
Netherlands Netherlands
Dr. Kadir Caliskan Dr. Faiz Ramjankhan
Groningen
Netherlands
Dr. Kevin Damman
Oslo Warsaw Zabrze Pamplona Bern Zürich Izmir Istanbul Ankara Ankara
Norway Poland Poland Spain Switzerland Switzerland Türkiye Türkiye Türkiye Türkiye
Prof. Arnt Fiane Prof. Bodan Maruszewski Prof. Marian Zembala Prof. Gregorio Rábago Prof. Paul Mohacsi Prof. Michael Hübler Prof. Mustafa Özbaran Dr. Erman Pektok Prof. Atilla Sezgin Prof. Ümit Kervan
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