Elham Kayvanpour1, Arjan Sammani2, Farbod Sedaghat-Hamedani1, David H Lehmann3, Alicia Broezel3, Jan Koelemenoglu3, Przemysław Chmielewski4, Angelique Curjol5, Pierre Socie6, Tobias Miersch3, Jan Haas1, Weng-Tein Gi1, Pascale Richard7, Rafał Płoski8, Grażyna Truszkowska8, Annette F Baas9, Bogna Foss-Nieradko10, Ewa Michalak10, Małgorzata Stępień-Wojno10, Joanna Zakrzewska-Koperska11, Mateusz Śpiewak12, Tomasz Zieliński13, Eric Villard14, Anneline S J M Te Riele15, Hugo A Katus1, Norbert Frey1, Zofia T Bilińska10, Philippe Charron16, Folkert W Asselbergs17, Benjamin Meder18. 1. University Hospital of Heidelberg, Cardiology, Heidelberg, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Germany. 2. Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands. 3. University Hospital of Heidelberg, Cardiology, Heidelberg, Germany. 4. Department of Medical Biology, The Cardinal Stefan Wyszyński National Institute of Cardiology, Warsaw, Poland. 5. APHP, Referral Center for Hereditary Heart Disease, Department of Genetics and Department of Cardiology, Pitié Salpêtrière Hospital, Paris, France. 6. APHP, Referral Center for Hereditary Heart Disease, Department of Genetics and Department of Cardiology, Pitié Salpêtrière Hospital, Paris, France; Department of Cardiology, Center Hospitalier de Chartres, Chartres, France. 7. APHP, UF Molecular Cardiogenetics and Myogenetics, Pitié Salpêtrière Hospital, Paris, France. 8. Molecular Biology Laboratory, Department of Medical Biology, National Institute of Cardiology, 04-628 Warsaw, Poland. 9. Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands. 10. Unit for Screening Studies in Inherited Cardiovascular Diseases, National Institute of Cardiology, 04-628 Warsaw, Poland. 11. Department of Arrhythmia, National Institute of Cardiology, 04-628 Warsaw, Poland. 12. Department of Radiology, National Institute of Cardiology, 04-628 Warsaw, Poland. 13. Department of Heart Failure and Transplantology, National Institute of Cardiology, 04-628 Warsaw, Poland. 14. Sorbonne Université, INSERM UMRS 1166 and ICAN Institute for Cardiometabolism and Nutrition, Paris, France. 15. Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands. 16. APHP, Referral Center for Hereditary Heart Disease, Department of Genetics and Department of Cardiology, Pitié Salpêtrière Hospital, Paris, France; Sorbonne Université, INSERM UMRS 1166 and ICAN Institute for Cardiometabolism and Nutrition, Paris, France. 17. Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands; Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK. 18. University Hospital of Heidelberg, Cardiology, Heidelberg, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Germany; Department of Genetics, Stanford Genome Technology Center, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: Benjamin.Meder@med.uni-heidelberg.de.
Abstract
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.
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.
Authors: Arjan Sammani; Rutger R van de Leur; Michiel T H M Henkens; Mathias Meine; Peter Loh; Rutger J Hassink; Daniel L Oberski; Stephane R B Heymans; Pieter A Doevendans; Folkert W Asselbergs; Anneline S J M Te Riele; René van Es Journal: Europace Date: 2022-10-13 Impact factor: 5.486
Authors: Cheuk To Chung; George Bazoukis; Sharen Lee; Ying Liu; Tong Liu; Konstantinos P Letsas; Antonis A Armoundas; Gary Tse Journal: Int J Arrhythmia Date: 2022-04-01