Predicting sudden cardiac death in adults with congenital heart disease
| Autor: | Diego Garcia-Hamilton, Javier Bermejo, Maria-Jose Rodriguez-Puras, Andres Alonso, Rocio Garcia-Orta, Pablo Ávila, Joaquín Rueda, Tomás Datino, Efrén Martínez-Quintana, Antonia Pijuan-Domenech, Laura Dos-Subirà, Rafael Peinado, Ana González, Francisco Fernández-Avilés, Pastora Gallego, José M. Oliver |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Heart Defects Congenital Male medicine.medical_specialty Heart disease Logistic regression Ventricular tachycardia Risk Assessment Sudden cardiac death QRS complex Internal medicine medicine Humans Prospective Studies Prospective cohort study business.industry Incidence Sudden cardiac arrest Middle Aged Prognosis medicine.disease Death Sudden Cardiac Logistic Models Case-Control Studies Cohort Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Digital.CSIC. Repositorio Institucional del CSIC instname |
| ISSN: | 1468-201X 1355-6037 |
| DOI: | 10.1136/heartjnl-2020-316791 |
| Popis: | [Objectives] To develop, calibrate, test and validate a logistic regression model for accurate risk prediction of sudden cardiac death (SCD) and non-fatal sudden cardiac arrest (SCA) in adults with congenital heart disease (ACHD), based on baseline lesion-specific risk stratification and individual’s characteristics, to guide primary prevention strategies. [Methods] We combined data from a single-centre cohort of 3311 consecutive ACHD patients (50% male) at 25-year follow-up with 71 events (53 SCD and 18 non-fatal SCA) and a multicentre case–control group with 207 cases (110 SCD and 97 non-fatal SCA) and 2287 consecutive controls (50% males). Cumulative incidences of events up to 20 years for specific lesions were determined in the prospective cohort. Risk model and its 5-year risk predictions were derived by logistic regression modelling, using separate development (18 centres: 144 cases and 1501 controls) and validation (two centres: 63 cases and 786 controls) datasets. [Results] According to the combined SCD/SCA cumulative 20 years incidence, a lesion-specific stratification into four clusters—very-low (12%)—was built. Multivariable predictors were lesion-specific cluster, young age, male sex, unexplained syncope, ischaemic heart disease, non-life threatening ventricular arrhythmias, QRS duration and ventricular systolic dysfunction or hypertrophy. The model very accurately discriminated (C-index 0.91; 95% CI 0.88 to 0.94) and calibrated (p=0.3 for observed vs expected proportions) in the validation dataset. Compared with current guidelines approach, sensitivity increases 29% with less than 1% change in specificity. [Conclusions] Predicting the risk of SCD/SCA in ACHD can be significantly improved using a baseline lesion-specific stratification and simple clinical variables. |
| Databáze: | OpenAIRE |
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