AN INDIVIDUALIZED RISK ASSESSMENT OF SUDDEN CARDIAC DEATH IN DILATION CARDIOMYOPATHY PATIENTS

• Main Authors: T. G. Vaykhanskaya, L. N. Sivitskaya, T. V. Kurushko, N. G. Danilenko, O. P. Melnikova, A. V. Frolov
• Format: Article
• Language: Russian
• Published: «FIRMA «SILICEA» LLC 2016-11-01
• Series: Российский кардиологический журнал
• Subjects: sudden cardiac death; dilation cardiomyopathy; markers of electrical instability of myocardium; lamin a/c genes mutation; risk stratification
• Online Access: https://russjcardiol.elpub.ru/jour/article/view/902

Search for effective methods of risk stratification in patients with higher risk of lifethreatening ventricular tachyarrhythmias (VTA) and sudden cardiac death is important task for applied healthcare and a priority scientific field.Aim. To invent a mathematic model and algorithm of individualized risk assessment for sudden cardiac death (SCD) in dilation cardiomyopathy patients (DCMP).Material and methods. Totally, 165 patients included, with verified DCMP (mean age 49,2±11,5 y; 135/81,8% males; NYHA class 2,67±0,45; LV ejection fraction 26,7±10,1%; follow-up 46,7±12,5 months). With an original software “Intecard 7”, with the data of 7-minute ECG-12 registration, we evaluated markers of electrical instability of myocardium — microvoltage alternans of T-waves (mATW), turbulence of cardiac rhythm (TCR), intervals QT and JT dispersion, acceleration and deceleration of cardiac rhythm. As primary endpoints for multifactorial Cox-analysis we used sustained ventricular tachicardia (VT) or ventricular fibrillation, shocks of implanted devices and documented SCD. We analyzed clinical, electrocardiographic, echocardiographic data and results of molecular-genetic study of lamin A/C gene (LMNA).Results. As result of multifactor regression analysis we found 2 cumulative independent predictors (HR 5,23; 95% CI 1,45-16,9; р=0,013) of life-threatening VTA events in DCMP patients: paroxysms of non-sustained VT (≥5 ventricular complexes with HR ≥150 bpm) and changes in LMNA gene (missense mutations and polymorhpism of 10 exon of rs4641). With binary logit-regression analysis of independent risk factors (VES, sVT, mATW, TCR, JTd and GLS LV) we built-up a model of binary regression (F=31,2; χ2=143,2; p=0,0000) and developed an algorithm of SCD risk evaluation that make it to classify with high prediction power up to 93,9%, cases of DCMP (OR 470; sensitivity 80,8%, specificity 99,1%).Conclusion. The invented algorithm of SCD risk is non-ivasive, individualized, easily applicable and interpretable technology that makes it to stratify patients with higher risk of life-threatening VTA with standard clinical and instrumental methods of investigation (ECG, EchoCG, Holter ECG). Implementation of the oroginal riskstratification model makes it to optimize tactics of DCMP patients treatment and strategy of selection of potential candidates for cardioverter-defibrillator implanting for primary SCD prevention.