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Comparison of different prediction models for the indication of implanted cardioverter defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy

2020; Wiley; Volume: 7; Issue: 6 Linguagem: Inglês

10.1002/ehf2.13019

2055-5822

Giovanni Donato Aquaro, Antonio De Luca, Chiara Cappelletto, Francesca Raimondi, Francesco Bianco, Nicoletta Botto, Andrea Barison, Simona Romani, Pierluigi Lesizza, Enrico Fabris, Giancarlo Todiere, Chrysanthos Grigoratos, Alessandro Pingitore, Davide Stolfo, Matteo Dal Ferro, Marco Merlo, Gianluca Di Bella, Gianfranco Sinagra,

Sports injuries and prevention

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with a high risk of sudden cardiac death. Three different prediction models for the indication of implanted cardioverter defibrillator (ICD) are now available: the 5 year ARVC risk score, the International Task Force Consensus (ITFC) criteria, and the Heart Rhythm Society (HRS) criteria. We compared these three prediction models in a validation cohort of patients with definite ARVC.In a cohort of 140 patients with definite ARVC, the 5 year ARVC risk score and the ITFC and HRS criteria were compared for the prediction of a major combined endpoint of sudden cardiac death, appropriate ICD intervention, resuscitated cardiac arrest, and sustained ventricular tachycardia. During the follow-up, 65 major events occurred. The 5 year ARVC risk score with a threshold >10%, derived from the maximally selected rank statistic, predicted 62 (95%) events [odds ratio (OR) 9.1, 95% confidence interval (CI) 2.6-32, P = 0.0006], the ITFC criteria 53 (81%, OR 4.8, 95% CI 2.2-10.3, P = 0.0001), and the HRS criteria 29 (45%, OR 4.2, 95% CI 1.9-9.3, P = 0.0003). At the analysis of decision curve for ICD implantation, a 5 year ARVC risk score >10% showed a greater net benefit than the ITFC and HRS criteria over a wide range of threshold probability of events. Finally, at multivariate analysis, the 5 year ARVC risk score >10% was the only independent predictor of major events.The 5 year score with a threshold of >10% was more effective for predicting events than the ITFC and HRS criteria.