Arrhythmic risk prediction in arrhythmogenic right ventricular cardiomyopathy: external validation of the arrhythmogenic right ventricular cardiomyopathy risk calculator.

Arrhythmic risk prediction in arrhythmogenic right ventricular cardiomyopathy: external validation of the arrhythmogenic right ventricular cardiomyopathy risk calculator.
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DOI:
10.1093/eurheartj/ehac289
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发表时间:
2022-08-21
影响因子:
39.3
通讯作者:
Cadrin-Tourigny, Julia
Cadrin-Tourigny, Julia
中科院分区:
医学1区
文献类型:
--
作者:
Jorda, Paloma;Bosman, Laurens P.;Gasperetti, Alessio;Mazzanti, Andrea;Gourraud, Jean-Baptiste;Davies, Brianna;Frederiksen, Tanja Charlotte;Moreno Weidmann, Zoraida;Di Marco, Andrea;Roberts, Jason D.;MacIntyre, Ciorsti;Seifer, Colette;Deliniere, Antoine;Alqarawi, Wael;Kukavica, Deni;Minois, Damien;Trancuccio, Alessandro;Arnaud, Marine;Targetti, Mattia;Martino, Annamaria;Oliviero, Giada;Pipilas, Daniel C.;Carbucicchio, Corrado;Compagnucci, Paolo;Dello Russo, Antonio;Olivotto, Iacopo;Calo, Leonardo;Lubitz, Steven A.;Cutler, Michael J.;Chevalier, Philippe;Arbelo, Elena;Giuliana Priori, Silvia;Healey, Jeffrey S.;Calkins, Hugh;Casella, Michela;Jensen, Henrik Kjaerulf;Tondo, Claudio;Tadros, Rafik;James, Cynthia A.;Krahn, Andrew D.;Cadrin-Tourigny, Julia

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致心律失常性右室心肌病 (ARVC) 会导致室性心律失常 (VA) 和心源性猝死 (SCD)。 2019 年,开发了一个风险预测模型,用于估计 ARVC 中 VA 事件的 5 年风险(ARVCrisk.com)。本研究旨在在大型国际多中心队列中从外部验证该预测模型,并将其性能与已发布的指南和专家共识推荐的植入式心律转复除颤器 (ICD) 使用的风险因素方法进行比较。在来自北美和欧洲 29 个中心的 429 名受试者的回顾性队列中,103 名受试者 (24%) 在诊断 ARVC 后的中位随访时间 5.02 (2.05–7.90) 年期间经历了持续的 VA。外部验证产生了良好的区分度 [C 指数 0.70(95% 置信区间 - CI 0.65–0.75)] 和校准斜率 1.01(95% CI 0.99–1.03)。与 ARVC 中 ICD 使用的三种已发表的基于共识的决策算法(心律失常性心肌病心律协会共识、ARVC 治疗国际工作组共识声明以及美国心脏协会 VA 和 SCD 指南)相比,风险计算器表现更好,净临床获益低于 35% 的风险阈值。这项研究使用大型独立患者队列,表明 ARVC 风险模型提供了良好的预后信息,并且优于其他已发布的 ICD 使用决策算法。这些发现支持使用该模型来促进关于 ICD 植入在 ARVC 中 SCD 一级预防中的共同决策。在不同队列中验证致心律失常性右室心肌病 (ARVC) 风险计算器。 AHA,美国心脏协会;心电图、心电图; HRS,心律协会; ICD,植入式心脏复律除颤器; ITFC,国际工作组标准; NSVT,非持续性室性心动过速; PVC,室性早搏; VA,室性心律失常。
Arrhythmogenic right ventricular cardiomyopathy (ARVC) causes ventricular arrhythmias (VAs) and sudden cardiac death (SCD). In 2019, a risk prediction model that estimates the 5-year risk of incident VAs in ARVC was developed (ARVCrisk.com). This study aimed to externally validate this prediction model in a large international multicentre cohort and to compare its performance with the risk factor approach recommended for implantable cardioverter-defibrillator (ICD) use by published guidelines and expert consensus. In a retrospective cohort of 429 individuals from 29 centres in North America and Europe, 103 (24%) experienced sustained VA during a median follow-up of 5.02 (2.05–7.90) years following diagnosis of ARVC. External validation yielded good discrimination [C-index of 0.70 (95% confidence interval-CI 0.65–0.75)] and calibration slope of 1.01 (95% CI 0.99–1.03). Compared with the three published consensus-based decision algorithms for ICD use in ARVC (Heart Rhythm Society consensus on arrhythmogenic cardiomyopathy, International Task Force consensus statement on the treatment of ARVC, and American Heart Association guidelines for VA and SCD), the risk calculator performed better with a superior net clinical benefit below risk threshold of 35%. Using a large independent cohort of patients, this study shows that the ARVC risk model provides good prognostic information and outperforms other published decision algorithms for ICD use. These findings support the use of the model to facilitate shared decision making regarding ICD implantation in the primary prevention of SCD in ARVC. Validation of the arrhythmogenic right ventricular cardiomyopathy (ARVC) risk calculator in a distinct cohort. AHA, American Heart Association; ECG, electrocardiogram; HRS, Heart Rhythm Society; ICD, implantable cardioverter-defibrillator; ITFC, International Task Force Criteria; NSVT, non-sustained ventricular tachycardia; PVC, premature ventricular complex; VA, ventricular arrhythmia.
DOI: 10.1161/circgen.120.003273
发表时间: 2021-06
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发表时间: 2020-08-01
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