Validation of the Minnesota Pectoralis Risk Score to predict mortality in the HeartMate 3 population

Chesney B Siems; Ziyu Ji; Zeina Jedeon; Jessica Schultz; Levi Teigen; Tadashi Allen; Ranjit John; Jerry D Estep; Maria Masotti; Tamas Alexy; Forum Kamdar; Valmiki Maharaj; Marc Pritzker; Daniel Garry; Andrew Shaffer; Rebecca Cogswell

doi:10.1016/j.healun.2023.11.003

Validation of the Minnesota Pectoralis Risk Score to predict mortality in the HeartMate 3 population

J Heart Lung Transplant. 2024 Apr;43(4):539-546. doi: 10.1016/j.healun.2023.11.003. Epub 2023 Nov 11.

Authors

Chesney B Siems¹, Ziyu Ji², Zeina Jedeon³, Jessica Schultz⁴, Levi Teigen⁵, Tadashi Allen⁶, Ranjit John⁷, Jerry D Estep⁸, Maria Masotti⁹, Tamas Alexy⁴, Forum Kamdar⁴, Valmiki Maharaj⁴, Marc Pritzker⁴, Daniel Garry⁴, Andrew Shaffer⁷, Rebecca Cogswell⁴

Affiliations

¹ Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota. Electronic address: siems029@umn.edu.
² Department of Biostatistics, University of Minnesota, Minneapolis, Minnesota.
³ Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
⁴ Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
⁵ Department of Food Science and Nutrition, University of Minnesota, Minneapolis, Minnesota.
⁶ Department of Diagnostic Radiology, University of Minnesota, Minneapolis, Minnesota.
⁷ Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
⁸ Department of Cardiology, Cleveland Clinic Florida, Weston, Florida.
⁹ Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.

PMID: 37956881
DOI: 10.1016/j.healun.2023.11.003

Abstract

Background: The Minnesota Pectoralis Risk Score (MPRS) utilizes computed tomography-quantified thoracic muscle and clinical variables to predict survival after left ventricular assist device (LVAD) implantation. The model has not been prospectively tested in HeartMate 3 recipients.

Methods: A single-center HeartMate 3 cohort from July 2016 to July 2021 (n = 108) was utilized for this analysis. Cohort subjects with complete covariates for MPRS calculation (pectoralis muscle measures, Black race, creatinine, total bilirubin, body mass index, bridge to transplant status, and presence/absence of contrast) implanted after MPRS development were included. MPRS were calculated on each subject. Receiver operating characteristic curves were generated to test model discrimination at 30-day, 90-day, and 1-year mortality post-LVAD. Next, the performance of the 1-year post-LVAD outcome was compared to the HeartMate 3 survival risk score (HM3RS).

Results: The mean age was 58 (15 years), 80% (86/108) were male, and 26% (28/108) were destination therapy. The area under the curve (AUC) for the MPRS model to predict post-LVAD mortality was 0.73 at 30 days, 0.78 at 90 days, and 0.81 at 1 year. The AUC for the HM3RS for the 1-year outcome was 0.693. Each 1-unit point of the MPRS was associated with a significant increase in the hazard rate of death after LVAD (hazard ratio 2.1, 95% confidence interval 1.5-3.0, p < 0.0001).

Conclusions: The MPRS had high performance in this prospective validation, particularly with respect to 90-day and 1-year post-LVAD mortality. Such a tool can provide additional information regarding risk stratification to aid informed decision-making.

Keywords: HeartMate 3; heart failure; left ventricular assist device; medical decision-making; mortality.

MeSH terms

Female
Heart Failure* / surgery
Heart-Assist Devices*
Humans
Male
Middle Aged
Minnesota
Proportional Hazards Models
Retrospective Studies
Risk Factors
Treatment Outcome