Risk stratifier for sudden cardiac death beyond the left ventricular ejection fraction in Chagas cardiomyopathy.
Roberto Coury Pedrosa, João Paulo do Vale Madeiro, Alex C Alberto, Gabriel A Limeira, Basílio de Bragança Pereira, Emília Matos do Nascimento, Fernando Soares Schlindwein, Gullien André Ng
Author Information
Roberto Coury Pedrosa: Cardiology Department, Clementino Fraga Filho University Hospital/Edson Saad Heart Institute-Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. ORCID
João Paulo do Vale Madeiro: Department of Computing Science-Federal University of Ceará, Fortaleza, Brazil.
Alex C Alberto: Federal Centre for Technological Education Celso Suckow da Fonseca, Rio de Janeiro, Brazil.
Gabriel A Limeira: Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Basílio de Bragança Pereira: Federal University of Rio de Janeiro, School of Medicine and Edson Saad Heart Institute, Rio de Janeiro, Brazil.
Emília Matos do Nascimento: State University of Rio de Janeiro, Rio de Janeiro, Brazil.
Fernando Soares Schlindwein: University of Leicester, School of Engineering, Leicester, UK.
Gullien André Ng: Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.
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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