A new prediction model for ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy.
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Cadrin-Tourigny Julia, Bosman Laurens P, Nozza Anna, Wang Weijia, Tadros Rafik, Bhonsale Aditya, Bourfiss Mimount, Fortier Annik, Lie Øyvind H, Saguner Ardan M, Svensson Anneli, Andorin Antoine, Tichnell Crystal, Murray Brittney, Zeppenfeld Katja, van den Berg Maarten P, Asselbergs Folkert W, Wilde Arthur A M, Krahn Andrew D, Talajic Mario, Rivard Lena, Chelko Stephen, Zimmerman Stefan L, Kamel Ihab R, Crosson Jane E, Judge Daniel P, Yap Sing-Chien, van der Heijden Jeroen F, Tandri Harikrishna, Jongbloed Jan D H, Guertin Marie-Claude, van Tintelen J Peter, Platonov Pyotr G, Duru Firat, Haugaa Kristina H, Khairy Paul, Hauer Richard N W, Calkins Hugh, Te Riele Anneline S J M, James Cynthia A
Аннотация
METHODS AND RESULTS: Five hundred and twenty-eight patients with a definite diagnosis and no history of sustained VAs/SCD at baseline, aged 38.2 ± 15.5 years, 44.7% male, were enrolled from five registries in North America and Europe. Over 4.83 (interquartile range 2.44-9.33) years of follow-up, 146 (27.7%) experienced sustained VA, defined as SCD, aborted SCD, sustained ventricular tachycardia, or appropriate implantable cardioverter-defibrillator (ICD) therapy. A prediction model estimating annual VA risk was developed using Cox regression with internal validation. Eight potential predictors were pre-specified: age, sex, cardiac syncope in the prior 6 months, non-sustained ventricular tachycardia, number of premature ventricular complexes in 24 h, number of leads with T-wave inversion, and right and left ventricular ejection fractions (LVEFs). All except LVEF were retained in the final model. The model accurately distinguished patients with and without events, with an optimism-corrected C-index of 0.77 [95% confidence interval (CI) 0.73-0.81] and minimal over-optimism [calibration slope of 0.93 (95% CI 0.92-0.95)]. By decision curve analysis, the clinical benefit of the model was superior to a current consensus-based ICD placement algorithm with a 20.6% reduction of ICD placements with the same proportion of protected patients (P < 0.001).
CONCLUSION: Using the largest cohort of patients with ARVC and no prior VA, a prediction model using readily available clinical parameters was devised to estimate VA risk and guide decisions regarding primary prevention ICDs (www.arvcrisk.com).