TY - JOUR
T1 - A novel risk model for predicting potentially life-threatening arrhythmias in non-ischemic dilated cardiomyopathy (DCM-SVA risk)
AU - Kayvanpour, Elham
AU - Sammani, Arjan
AU - Sedaghat-Hamedani, Farbod
AU - Lehmann, David H
AU - Broezel, Alicia
AU - Koelemenoglu, Jan
AU - Chmielewski, Przemysław
AU - Curjol, Angelique
AU - Socie, Pierre
AU - Miersch, Tobias
AU - Haas, Jan
AU - Gi, Weng-Tein
AU - Richard, Pascale
AU - Płoski, Rafał
AU - Truszkowska, Grażyna
AU - Baas, Annette F
AU - Foss-Nieradko, Bogna
AU - Michalak, Ewa
AU - Stępień-Wojno, Małgorzata
AU - Zakrzewska-Koperska, Joanna
AU - Śpiewak, Mateusz
AU - Zieliński, Tomasz
AU - Villard, Eric
AU - Te Riele, Anneline S J M
AU - Katus, Hugo A
AU - Frey, Norbert
AU - Bilińska, Zofia T
AU - Charron, Philippe
AU - Asselbergs, Folkert W
AU - Meder, Benjamin
N1 - Copyright © 2021 Elsevier B.V. All rights reserved.
PY - 2021/9/15
Y1 - 2021/9/15
N2 - 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 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 non-ischemic DCM using easily accessible clinical information and will likely reduce overtreatment.
AB - 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 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 non-ischemic DCM using easily accessible clinical information and will likely reduce overtreatment.
KW - Adult
KW - Aged
KW - Arrhythmias, Cardiac/diagnosis
KW - Cardiomyopathy, Dilated/diagnosis
KW - Death, Sudden, Cardiac/epidemiology
KW - Defibrillators, Implantable
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Risk Factors
KW - Stroke Volume
KW - Ventricular Function, Left
U2 - https://doi.org/10.1016/j.ijcard.2021.07.002
DO - https://doi.org/10.1016/j.ijcard.2021.07.002
M3 - Article
C2 - 34245791
SN - 0167-5273
VL - 339
SP - 75
EP - 82
JO - International journal of cardiology
JF - International journal of cardiology
ER -