A novel risk model for predicting potentially life-threatening arrhythmias in non-ischemic dilated cardiomyopathy (DCM-SVA risk

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:339

Article

Kayvanpour, Elham^1,2  Sedaghat-Hamedani, Farbod^1,2  Lehmann, David H.¹  Broezel, Alicia¹  Koelemenoglu, Jan¹  Curjol, Angelique³  Socie, Pierre^3,4,5  Miersch, Tobias¹  Haas, Jan^1,2  Gi, Weng-Tein^1,2  Richard, Pascale⁶  Ploski, Rafal⁷  Truszkowska, Grazyna⁷  Baas, Annette F.⁸  Foss-Nieradko, Bogna^9,10  Michalak, Ewa^9,10  Stepien-Wojno, Malgorzata^9,10  Zakrzewska-Koperska, Joanna¹¹  Spiewak, Mateusz¹²  Zielinski, Tomasz¹³  Villard, Eric¹⁴  Riele, Anneline S. J. M. te^15,16,17  Katus, Hugo A.^1,2  Frey, Norbert^1,2  Bilinska, Zofia T.^9,10  Charron, Philippe³  Asselbergs, Folkert W.¹⁸  Meder, Benjamin^1,2,19,20,21 

[1] Univ Hosp Heidelberg, Cardiol, Heidelberg, Germany

[2] German Ctr Cardiovasc Res, Partner Site Heidelberg Mannheim, Heidelberg, Germany

[3] Cardinal Stefan Wyszynski Natl Inst Cardiol, Dept Med Biol, Warsaw, Poland

[4] Assistance Publ Hop Paris Ctr, Referral Ctr Hereditary Heart Dis, Dept Genet, Paris, France

[5] Hop La Pitie Salpetriere, Dept Cardiol, Paris, France

[6] Ctr Hosp Chartres, Dept Cardiol, Chartres, France

[7] Hop La Pitie Salpetriere, APHP, UF Mol Cardiogenet & Myogenet, Paris, France

[8] Natl Inst Cardiol, Dept Med Biol, Mol Biol Lab, PL-04628 Warsaw, Poland

[9] Univ Utrecht, Utrecht, Netherlands

[10] Univ Med Ctr Utrecht, Dept Genet, Div Labs Pharm & Biomed Genet, Utrecht, Netherlands

[11] Natl Inst Cardiol, Unit Screening Studies Inherited Cardiovasc Dis, PL-04628 Warsaw, Poland

[12] Natl Inst Cardiol, Dept Arrhythmia, PL-04628 Warsaw, Poland

[13] Natl Inst Cardiol, Dept Radiol, PL-04628 Warsaw, Poland

[14] Natl Inst Cardiol, Dept Heart Failure & Transplantol, PL-04628 Warsaw, Poland

[15] Sorbonne Univ, Paris, France

[16] ICAN Inst Cardiometab & Nutr, Paris, France

[17] INSERM, UMRS 1166, Paris, France

[18] Netherlands Heart Inst, Utrecht, Netherlands

[19] UCL, Inst Cardiovasc Sci, Fac Populat Hlth Sci, London, England

[20] UCL, Inst Hlth Informat, Fac Populat Hlth Sci, London, England

[21] Stanford Univ Sch Med, Stanford Genome Technol Ctr, Dept Genet, Stanford, CA USA

关键词: Dilated cardiomyopathy;    Sustained ventricular arrhythmia;    Risk calculator;   

DOI  :  10.1016/j.ijcard.2021.07.002

来源: Elsevier

【 摘 要 】

Background: Non-ischemic dilated cardiomyopathy (DCM) can be complicated by sustained ventricular arrhythmias (SVA) and sudden cardiac death (SCD). By now, left-ventricular ejection fraction (LV-EF) is the main guideline criterion for primary prophylactic ICD implantation, potentially leading either to overtreatment or failed detection of patients at risk without severely impaired LV-EF. The aim of the European multi-center study DETECTIN-HF was to establish a clinical risk calculator for individualized risk stratification of DCM patients. Methods: 1393 patients (68% male, mean age 50.7 +/- 14.3y) from four European countries were included. The outcome was occurrence of first potentially life-threatening ventricular arrhythmia. The model was developed using Cox proportional hazards, and internally validated using cross validation. The model included seven of Cardiology 339 (2021) independent and easily accessible clinical parameters sex, history of non-sustained ventricular tachycardia, history of syncope, family history of cardiomyopathy, QRS duration, LV-EF, and history of atrial fibrillation. The model was also expanded to account for presence of LGE as the eight8h parameter for cases with available cMRI and scar information. Results: During a mean follow-up period of 57.0 months, 193 (13.8%) patients experienced an arrhythmic event. The calibration slope of the developed model was 00.97 (95% CI 0.90-1.03) and the C-index was 0.72 (95% CI 0.71-0.73). Compared to current guidelines, the model was able to protect the same number of patients (5-year risk >8.5%) with 15% fewer ICD implantations. Conclusions: This DCM-SVA risk model could improve decision making in primary prevention of SCD in nonischemic DCM using easily accessible clinical information and will likely reduce overtreatment.

【 授权许可】

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