Incidence of and Risk Factors for Sudden Cardiac Death in Children With Dilated Cardiomyopathy A Report From the Pediatric Cardiomyopathy Registry

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:59

Article

Pahl, Elfriede¹  Sleeper, Lynn A.²  Canter, Charles E.³  Hsu, Daphne T.⁴  Lu, Minmin²  Webber, Steven A.⁵  Colan, Steven D.^6,7  Kantor, Paul F.⁸  Everitt, Melanie D.⁹  Towbin, Jeffrey A.¹⁰  Jefferies, John L.¹⁰  Kaufman, Beth D.¹¹  Wilkinson, James D.¹²  Lipshultz, Steven E.¹² 

[1] Northwestern Univ, Childrens Mem Hosp, Div Cardiol, Chicago, IL 60614 USA

[2] New England Res Inst Inc, Watertown, MA USA

[3] Washington Univ, St Louis, MO USA

[4] Childrens Hosp Montefiore, Bronx, NY USA

[5] Univ Pittsburgh, Pittsburgh, PA USA

[6] Childrens Hosp, Dept Cardiol, Boston, MA 02115 USA

[7] Harvard Univ, Sch Med, Dept Pediat, Boston, MA 02115 USA

[8] Hosp Sick Children, Toronto, ON M5G 1X8, Canada

[9] Primary Childrens Med Ctr, Salt Lake City, UT 84103 USA

[10] Cincinnati Childrens Hosp, Med Ctr, Inst Heart, Cincinnati, OH USA

[11] Univ Penn, Philadelphia, PA 19104 USA

[12] Univ Miami, Miller Sch Med, Dept Pediat, Miami, FL 33136 USA

关键词: cardiomyopathy;    heart failure;    pediatrics;    sudden death;   

DOI  :  10.1016/j.jacc.2011.10.878

来源: Elsevier

【 摘 要 】

Objectives The purpose of this study was to establish the incidence of and risk factors for sudden cardiac death (SCD) in pediatric dilated cardiomyopathy (DCM). Background The incidence of SCD in children with DCM is unknown. The ability to predict patients at high risk of SCD will help to define who may benefit most from implantable cardioverter-defibrillators. Methods The cohort was 1,803 children in the PCMR (Pediatric Cardiomyopathy Registry) with a diagnosis of DCM from 1990 to 2009. Cumulative incidence competing-risks event rates were estimated. We achieved risk stratification using Classification and Regression Tree methodology. Results The 5-year incidence rates were 29% for heart transplantation, 12.1% non-SCD, 4.0% death from unknown cause, and 2.4% for SCD. Of 280 deaths, 35 were SCD, and the cause was unknown for 56. The 5-year incidence rate for SCD incorporating a subset of the unknown deaths is 3%. Patients receiving antiarrhythmic medication were at higher risk of SCD (hazard ratio: 3.0, 95% confidence interval: 1.1 to 8.3, p = 0.025). A risk stratification model based on most recent echocardiographic values had 86% sensitivity and 57% specificity. Thirty of 35 SCDs occurred in patients who met all these criteria: left ventricular (LV) end-systolic dimension z-score >2.6, age at diagnosis younger than 14.3 years, and the LV posterior wall thickness to end-diastolic dimension ratio <0.14. Sex, ethnicity, cause of DCM, and family history were not associated with SCD. Conclusions The 5-year incidence rate of SCD in children with DCM is 3%. A risk stratification rule (86% sensitivity) included age at diagnosis younger than 14.3 years, LV dilation, and LV posterior wall thinning. Patients who consistently meet these criteria should be considered for implantable cardioverter-defibrillator placement. (Pediatric Cardiomyopathy Registry; NCT00005391) (J Am Coll Cardiol 2012;59:607-15) (C) 2012 by the American College of Cardiology Foundation

【 授权许可】

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