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Войти в исследования Risk factors for lethal arrhythmic events in children and adolescents with hypertrophic cardiomyopathy and an implantable defibrillator: An international multicenter study.
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Balaji Seshadri, DiLorenzo Michael P, Fish Frank A, Etheridge Susan P, Aziz Peter F, Russell Mark W, Tisma Svjetlana, Pflaumer Andreas, Sreeram Narayanswami, Kubus Peter, Law Ian H, Kantoch Michal J, Kertesz Naomi J, Strieper Margaret, Erickson Christopher C, Moore Jeremy P, Nakano Stephanie J, Singh Harinder R, Chang Philip, Cohen Mitchell, Fournier Anne, Ilina Maria V, Smith Richard T, Zimmerman Frank, Horndasch Michaela, Li Walter, Batra Anjan, Liberman Leonardo, Hamilton Robert, Janson Christopher M, Sanatani Shubhayan, Zeltser Ilana, McDaniel George, Blaufox Andrew D, Garnreiter Jason M, Katcoff Hannah, Shah Maully
Аннотация
OBJECTIVE: The purpose of this study was to determine predictors of LAE in children with HCM.
METHODS: A retrospective data collection was performed on 446 children and teenagers 20 years and younger (290 [65%] male; mean age 10.1 ± 5.7 years) with idiopathic HCM from 35 centers. Patients were classified as group 1 (HCM with LAE) if having a secondary prevention implantable cardioverter-defibrillator (ICD) or primary prevention ICD with appropriate interventions or group 2 (HCM without LAE) if having a primary prevention ICD without appropriate interventions.
RESULTS: There were 152 children (34%) in group 1 and 294 (66%) in group 2. Risk factors for group 1 by univariate analysis were septal thickness, posterior left ventricular (LV) wall thickness, lower LV outflow gradient, and Q wave > 3 mm in inferior electrocardiographic leads. Factors not associated with LAE were family history of SCD, abnormal blood pressure response to exercise, and ventricular tachycardia on ambulatory electrocardiographic monitoring. Risk factors for SCD by multivariate analysis were age at ICD placement (hazard ratio [HR] 0.9; P = .0025), LV posterior wall thickness z score (HR 1.02; P < .005), and LV outflow gradient < 30 mm Hg (HR 2.0; P < .006). LV posterior wall thickness z score ≥ 5 was associated with LAE.
CONCLUSION: Risk factors for LAE appear different in children compared to adults. Conventional adult risk factors were not significant in children. Further prospective studies are needed to improve risk stratification for LAE in children with HCM.