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Войти в исследования Catecholaminergic polymorphic ventricular tachycardia mediated by ryanodine receptor 2: a validated risk stratification.
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Lieve Krystien V, van der Werf Christian, Kallas Dania, Denjoy Isabelle, Bos J Martijn, Aiba Takeshi, Behr Elijah R, van den Berg Maarten P, Bergeman Auke T, Blom Nico A, Borggrefe Martin, Brugada Ramon, Carrillo Mora Lidia María, Chorin Ehud, Crotti Lia, Davis Andrew, Drago Fabrizio, Dusi Veronica, Extramiana Fabrice, Franciosi Sonia, Giudicessi John R, González Llopis Francisco Ángel, Haugaa Kristina H, van den Heuvel Freek, Horie Minoru, Ingles Jodie, Kammeraad Janneke, Kannankeril Prince J, Khan Habib R, Krahn Andrew D, MacIntyre Ciorsti, Maltret Alice, Marjamaa Annukka, Ohno Seiko, Peltenburg Puck J, Perez Guillermo J, Probst Vincent, Roberts Jason D, Robyns Tomas, Rootwelt-Norberg Christine, Roses I Noguer Ferran, Roston Thomas M, Rydberg Annika, Sacher Frederic, Sarquella-Brugada Georgia, Schwartz Peter J, Semsarian Christopher, Shimizu Wataru, Starling Luke, Sumitomo Naokata, Skinner Jonathan R, Tavacova Terezia, Tfelt-Hansen Jacob, Till Janice A, Yap Sing-Chien, Wada Yuko, Wangüemert Fernando, Zorio Esther, Ackerman Michael J, Leenhardt Antoine, Sanatani Shubhayan, Tanck Michael W, Wilde Arthur A
Аннотация
METHODS: The derivation and independent validation cohorts included 743 and 129 patients, respectively. AEs were defined as arrhythmic syncope, appropriate implantable cardioverter-defibrillator shock, sudden cardiac arrest (SCA), and sudden cardiac death. Near-fatal or fatal AEs (nf/fAEs) included all AEs except for arrhythmic syncope. Prediction models using Cox regression were developed and internally and externally validated.
RESULTS: A total of 102 (13.7%) patients in the derivation cohort and 24 (18.6%) patients in the validation cohort experienced ≥1 AE over a median follow-up of 5.1 [interquartile range (IQR), 7.7] and 2.4 (IQR, 4.4) years, respectively. Predictors of AE were arrhythmic syncope or SCA prior to diagnosis and age at β-blocker initiation. In the derivation and validation cohorts, the optimism-corrected C-indices of the models for AE were 0.67 [95% confidence interval (CI) 0.62-0.72] and 0.59 (95% CI 0.48-0.71), respectively. For nf/fAEs, ventricular arrhythmia severity before β-blocker initiation was a fourth independent predictor, and C-indices of the models in the derivation and validation cohorts were 0.74 (95% CI 0.68-0.80) and 0.60 (95% CI 0.47-0.72), respectively. In the derivation cohort, calibration slopes were 1.00 (95% CI 0.59-1.41) for AE and 1.00 (95% CI 0.69-1.32) for nf/fAE.
CONCLUSIONS: These externally validated risk prediction models using clinical parameters accurately distinguished CPVT patients on β-blocker monotherapy at low and high risk for future AEs while treated with β-blockers. These models provide guidance for implementation of clinical management therapies to prevent AEs in patients with CPVT.