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 - Funding Information:
This work was supported by grants from the Deutsches Zentrum für Herz-Kreislauf-Forschung (German Center for Cardiovascular Research, DZHK) , the German Ministry of Education and Research (CaRNAtion, FKZ 031L0075B ), Informatics for Life (Klaus Tschira Foundation), Polish National Center for Research and Development, Assistance Publique-Hôpitaux de Paris [ PHRC programme hospitalier de recherche Clinique , AOM04041 ], PROMEX charitable foundation, and the European Union ( ERA-CVD DETECTIN-HF ). Elham Kayvanpour was partially funded by the DZHK ( 81X3500117 ). Arjan Sammani was supported by the Alexandre Suerman Stipendium and CVON 2015-12 eDETECT YTP. Annette Baas was supported by Netherlands Heart Foundation (Dekker 2015T041 ). Anneline te Riele was supported by the Dutch Heart Foundation ( 2015T058 ), the UMC Utrecht Fellowship Clinical Research Talent and CVON 2015–12 eDETECT. Folkert Asselbergs was supported by UCL Hospitals NIHR Biomedical Research Center . Benjamin Meder was supported by an excellence fellowship of the Else Kröner Fresenius Foundation .
Publisher Copyright:
© 2021 Elsevier B.V.
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 - Dilated cardiomyopathy
KW - Risk calculator
KW - Sustained ventricular arrhythmia
UR - http://www.scopus.com/inward/record.url?scp=85110549570&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2021.07.002
DO - 10.1016/j.ijcard.2021.07.002
M3 - Article
C2 - 34245791
AN - SCOPUS:85110549570
SN - 0167-5273
VL - 339
SP - 75
EP - 82
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -