Novel risk calculator performance in athletes with arrhythmogenic right ventricular cardiomyopathy
Novel risk calculator performance in athletes with arrhythmogenic right ventricular cardiomyopathy
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DOI：
10.1016/j.hrthm.2020.03.007
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发表时间：
2020-08-01
期刊：
影响因子：
5.5
通讯作者：
Casella, Michela
中科院分区：
文献类型：
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作者：
Gasperetti, Alessio;Dello Russo, Antonio;Casella, Michela
背景致心律失常性右室心肌病（ARVC）的疾病进展和室性心律失常（VAs）与体育锻炼相关，建议ARVC患者临床去训练和避免竞技体育锻炼。Cadrin-Tourigny等人最近开发了一种评估ARVC患者原发性心律失常风险的算法。关于其对运动员的可转移性的数据缺乏。本研究的目的是评估Cadrin-Tourigny风险预测算法在ARVC运动员队列中的可靠性，并描述临床去训练对疾病进展的影响。方法纳入所有在我院确诊ARVC后接受临床去训练的运动员。收集基线和随访的临床特征以及随访期间发生的VA事件的数据。采用Cadrin-Tourigny算法计算VA的先验预测风险，并与观察结果进行比较。结果入选25名确诊ARVC并接受临床去训练的运动员（年龄36.1±14.0岁，80%为男性）。在中位（四分位数范围）随访5.3（3.2-6.6）年期间，评估了室性早衰（PVC）负担的减少（P = 0.001），记录了10例室性早衰事件（40%）。先验算法预测的风险似乎与观察到的队列心律失常风险相符[5年平均观察预测风险差异-0.85%（四分位数间差-4.8%至13.1%）；P = .85]。随访1年，11例（44%）患者应激心电图反应改善，右心室射血分数无明显变化。结论：临床去训练与ARVC运动员的PVC负担减轻有关。这种新的风险预测算法对于ARVC运动员的应用似乎不需要任何修正。
BACKGROUND Disease progression and ventricular arrhythmias (VAs) in arrhythmogenic right ventricular cardiomyopathy (ARVC) are correlated with physical exercise, and clinical detraining and avoidance of competitive sport practice are suggested for ARVC patients. An algorithm assessing primary arrhythmic risk in ARVC patients was recently developed by Cadrin-Tourigny et al. Data regarding its transferability to athletes are lacking.OBJECTIVE The purpose of this study was to assess the reliability of the Cadrin-Tourigny risk prediction algorithm in a cohort of athletes with ARVC and to describe the impact of clinical detraining on disease progression.METHODS All athletes undergoing clinical detraining after ARVC diagnosis at our institution were enrolled. Baseline and follow-up clinical characteristics and data on VA events occurring during follow-up were collected. The Cadrin-Tourigny algorithm was used to calculate the a priori predicted VA risk, which was compared with the observed outcomes.RESULTS Twenty-five athletes (age 36.1 +/- 14.0 years; 80% male) with definite ARVC who were undergoing clinical detraining were enrolled. Over median (interquartile range) follow-up of 5.3 (3.2-6.6) years, a reduction in premature ventricular complex (PVC) burden (P = .001) was assessed, and 10 VA events (40%) were recorded. The a priori algorithm-predicted risk seemed to fit with the observed cohort arrhythmic risk [mean observed-predicted risk difference over 5 years -0.85% (interquartile range -4.8% to 13.1%); P = .85]. At 1-year follow-up, 11 patients (44%) had an improved stress ECG response, and no significant changes in right ventricular ejection fraction were observed.CONCLUSION Clinical detraining is associated with PVC burden reduction in athletes with ARVC. The novel risk prediction algorithm does not seem to require any correction for its application to ARVC athletes.