Risk stratifier for sudden cardiac death beyond the left ventricular ejection fraction in Chagas cardiomyopathy
Roberto Coury Pedrosa1, João Paulo do Vale Madeiro2, Alex C Alberto3
1Cardiology Department, Clementino Fraga Filho University Hospital/Edson Saad Heart Institute-Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Insights
Sudden cardiac death (SCD) risk in Chagas cardiomyopathy can be predicted using action potential duration restitution (APDR) dynamics. This method identifies patients at high risk for SCD, aiding clinical decision-making.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Informatics
Background:
- Chagas cardiomyopathy (CC) lacks reliable sudden cardiac death (SCD) risk markers.
- Action potential duration restitution (APDR) dynamics offers insights into cardiac regional heterogeneity.
- There is a need for patient-specific algorithms to predict SCD in specific CC risk subgroups.
Purpose of the Study:
- To develop and validate a patient-specific algorithm for predicting SCD in low-to-intermediate Rassi risk score subgroups of Chagas cardiomyopathy.
- To assess the utility of APDR dynamics as an adjunct tool for SCD risk stratification.
Main Methods:
- A cross-sectional study analyzed 24-h Holter ECG data from 221 patients (1992-2017).
- RR series were generated from 4-h ECG segments to calculate APDR dynamics metrics.
- Classification tree and sensitivity analyses were employed, incorporating 34 variables and SCD outcomes.
Main Results:
- The SCD group exhibited increased ventricular remodeling and electrical instability compared to the SCD-free group.
- A %beats QTend/TendQ ratio > 1 in over 56.7% of 4-h ECG segments effectively identified patients in the SCD subgroup (AUC, 0.96).
- Variables reflecting different stages of Chagas cardiomyopathy were significant predictors.
Conclusions:
- APDR dynamics can serve as an effective adjuvant for SCD risk assessment in specific Chagas cardiomyopathy patient subgroups.
- This approach demonstrates high discriminatory power for identifying patients at high risk of SCD with low risk of non-cardiovascular death.
Background:
Sudden cardiac death (SCD) risk markers are needed in Chagas cardiomyopathy (CC). Action potential duration restitution (APDR) dynamics is capable of extracting information on cardiac regional heterogeneity. This study intends to develop a patient-specific variables-based algorithm to predict SCD in the low-intermediate subgroups of the Rassi risk score.
Methods:
Cross-sectional study of patients who underwent 24-h Holter for research purposes between January 1992 and February 2017. From 4-h ECG segment, RR series were generated and APDR dynamics metrics were calculated. Classification tree and sensitivity analysis were applied. As outcomes, SCD, SCD-free and non-cardiovascular death and 34 variables were included.
Results:
Two hundred twenty-one (129 in the group SCD-free, 80 in the SCD group and 12 non-cardiovascular death group) were analyzed. In the groups with and without SCD (209 patients), the median age was 66 years, 52% were female, the cardiac involvement was mild to moderate in 72% with a Rassi point median of 8 (IQ: 3 to 11). The SCD group had more ventricular remodeling and more ventricular electrical instability. The occurrence of a %beats QTend/TendQ ratio > 1 (AUC, 0.96 (95% CI 0.89-0.98) present in more than 56.7% of the 4-h ECG segments was sufficient to identify patients of the SCD subgroup. Variables representing different stages of CC were also relevant in the model.
Conclusion:
It is possible to use APDR dynamics as an adjuvant in the SCD risk assessment in a subgroup of patients with a high risk of SCD and a very low risk of non-CV death with high power of discrimination.
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