Tool created to identify DCM children at risk for sudden cardiac death

6 February 2012

MedWire News: Researchers have created a risk stratification tool to identify patients with pediatric dilated cardiomyopathy (DCM) who are at risk for sudden cardiac death (SCD).

Patients who consistently meet the criteria included in the model should be considered for implantable cardioverter-defibrillator (ICD) placement, say Elfriede Pahl (Children’s Memorial Hospital, Chicago, Illinois, USA) and colleagues in the Journal of the American College of Cardiology.

Their analysis included a cohort of 1803 children in the Pediatric Cardiomyopathy Registry who were diagnosed with DCM between 1990 and 2009. The researchers estimated cumulative incidence competing-risks even rates and used Classification and Regression Tree methodology to achieve risk stratification.

Overall, the 5-year incidence for heart transplantation was 29%. It was 12.1% for non-SCD, 4.0% for death from unknown cause, and 2.4% for SCD. Of 280 deaths in total, 35 were attributed to SCD and 56 were due to unknown causes. The 5-year incidence rate for SCD incorporating a subset of the unknown deaths was 3%.

Patients who received antiarrhythmic medications were at a threefold higher risk for SCD (p=0.025) than those who did not.

Multivariate analysis that took into account recent echocardiographic measurements, age, and the presence of congestive heart failure at diagnosis demonstrated that a left ventricular (LV) end-systolic dimension z-score of more than 2.6, being younger than 14.3 years, and an LV posterior wall thickness to end-diastolic dimension ratio of less than 0.14 were significant predictors for SCD.

Indeed, 30 of 35 SCDs occurred in patients who met all three of these criteria. This model had a sensitivity of 86% and a specificity of 57% for predicting SCD.

“Our data support the concept that universal implantation of ICDs is probably not warranted,” write the authors.

“However, risk stratification is possible and is strengthened by a patient’s condition meeting all the high-risk criteria for an extended period. In such situations. ICD placement should be considered for pediatric patients with DCM.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

J Am Coll Cardiol 2012; 59: 607–615