Incidence of and risk factors for sudden cardiac death in children with dilated cardiomyopathy

A report from the pediatric cardiomyopathy registry

Elfriede Pahl, Lynn A. Sleeper, Charles E. Canter, Daphne T. Hsu, Minmin Lu, Steven A. Webber, Steven D. Colan, Paul F. Kantor, Melanie D. Everitt, Jeffrey A. Towbin, John L. Jefferies, Beth D. Kaufman, James D. Wilkinson, Steven E. Lipshultz

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to establish the incidence of and risk factors for sudden cardiac death (SCD) in pediatric dilated cardiomyopathy (DCM). Background: The incidence of SCD in children with DCM is unknown. The ability to predict patients at high risk of SCD will help to define who may benefit most from implantable cardioverter-defibrillators. Methods: The cohort was 1,803 children in the PCMR (Pediatric Cardiomyopathy Registry) with a diagnosis of DCM from 1990 to 2009. Cumulative incidence competing-risks event rates were estimated. We achieved risk stratification using Classification and Regression Tree methodology. Results: The 5-year incidence rates were 29% for heart transplantation, 12.1% non-SCD, 4.0% death from unknown cause, and 2.4% for SCD. Of 280 deaths, 35 were SCD, and the cause was unknown for 56. The 5-year incidence rate for SCD incorporating a subset of the unknown deaths is 3%. Patients receiving antiarrhythmic medication were at higher risk of SCD (hazard ratio: 3.0, 95% confidence interval: 1.1 to 8.3, p = 0.025). A risk stratification model based on most recent echocardiographic values had 86% sensitivity and 57% specificity. Thirty of 35 SCDs occurred in patients who met all these criteria: left ventricular (LV) end-systolic dimension z-score >2.6, age at diagnosis younger than 14.3 years, and the LV posterior wall thickness to end-diastolic dimension ratio <0.14. Sex, ethnicity, cause of DCM, and family history were not associated with SCD. Conclusions: The 5-year incidence rate of SCD in children with DCM is 3%. A risk stratification rule (86% sensitivity) included age at diagnosis younger than 14.3 years, LV dilation, and LV posterior wall thinning. Patients who consistently meet these criteria should be considered for implantable cardioverter-defibrillator placement. (Pediatric Cardiomyopathy Registry; NCT00005391)

Original languageEnglish (US)
Pages (from-to)607-615
Number of pages9
JournalJournal of the American College of Cardiology
Volume59
Issue number6
DOIs
StatePublished - Feb 7 2012
Externally publishedYes

Fingerprint

Sudden Cardiac Death
Dilated Cardiomyopathy
Cardiomyopathies
Registries
Pediatrics
Incidence
Implantable Defibrillators
Aptitude
Heart Transplantation
Dilatation
Cause of Death
Confidence Intervals
Sensitivity and Specificity

Keywords

  • cardiomyopathy
  • heart failure
  • pediatrics
  • sudden death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Incidence of and risk factors for sudden cardiac death in children with dilated cardiomyopathy : A report from the pediatric cardiomyopathy registry. / Pahl, Elfriede; Sleeper, Lynn A.; Canter, Charles E.; Hsu, Daphne T.; Lu, Minmin; Webber, Steven A.; Colan, Steven D.; Kantor, Paul F.; Everitt, Melanie D.; Towbin, Jeffrey A.; Jefferies, John L.; Kaufman, Beth D.; Wilkinson, James D.; Lipshultz, Steven E.

In: Journal of the American College of Cardiology, Vol. 59, No. 6, 07.02.2012, p. 607-615.

Research output: Contribution to journalArticle

Pahl, E, Sleeper, LA, Canter, CE, Hsu, DT, Lu, M, Webber, SA, Colan, SD, Kantor, PF, Everitt, MD, Towbin, JA, Jefferies, JL, Kaufman, BD, Wilkinson, JD & Lipshultz, SE 2012, 'Incidence of and risk factors for sudden cardiac death in children with dilated cardiomyopathy: A report from the pediatric cardiomyopathy registry', Journal of the American College of Cardiology, vol. 59, no. 6, pp. 607-615. https://doi.org/10.1016/j.jacc.2011.10.878
Pahl, Elfriede ; Sleeper, Lynn A. ; Canter, Charles E. ; Hsu, Daphne T. ; Lu, Minmin ; Webber, Steven A. ; Colan, Steven D. ; Kantor, Paul F. ; Everitt, Melanie D. ; Towbin, Jeffrey A. ; Jefferies, John L. ; Kaufman, Beth D. ; Wilkinson, James D. ; Lipshultz, Steven E. / Incidence of and risk factors for sudden cardiac death in children with dilated cardiomyopathy : A report from the pediatric cardiomyopathy registry. In: Journal of the American College of Cardiology. 2012 ; Vol. 59, No. 6. pp. 607-615.
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T1 - Incidence of and risk factors for sudden cardiac death in children with dilated cardiomyopathy

T2 - A report from the pediatric cardiomyopathy registry

AU - Pahl, Elfriede

AU - Sleeper, Lynn A.

AU - Canter, Charles E.

AU - Hsu, Daphne T.

AU - Lu, Minmin

AU - Webber, Steven A.

AU - Colan, Steven D.

AU - Kantor, Paul F.

AU - Everitt, Melanie D.

AU - Towbin, Jeffrey A.

AU - Jefferies, John L.

AU - Kaufman, Beth D.

AU - Wilkinson, James D.

AU - Lipshultz, Steven E.

PY - 2012/2/7

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N2 - Objectives: The purpose of this study was to establish the incidence of and risk factors for sudden cardiac death (SCD) in pediatric dilated cardiomyopathy (DCM). Background: The incidence of SCD in children with DCM is unknown. The ability to predict patients at high risk of SCD will help to define who may benefit most from implantable cardioverter-defibrillators. Methods: The cohort was 1,803 children in the PCMR (Pediatric Cardiomyopathy Registry) with a diagnosis of DCM from 1990 to 2009. Cumulative incidence competing-risks event rates were estimated. We achieved risk stratification using Classification and Regression Tree methodology. Results: The 5-year incidence rates were 29% for heart transplantation, 12.1% non-SCD, 4.0% death from unknown cause, and 2.4% for SCD. Of 280 deaths, 35 were SCD, and the cause was unknown for 56. The 5-year incidence rate for SCD incorporating a subset of the unknown deaths is 3%. Patients receiving antiarrhythmic medication were at higher risk of SCD (hazard ratio: 3.0, 95% confidence interval: 1.1 to 8.3, p = 0.025). A risk stratification model based on most recent echocardiographic values had 86% sensitivity and 57% specificity. Thirty of 35 SCDs occurred in patients who met all these criteria: left ventricular (LV) end-systolic dimension z-score >2.6, age at diagnosis younger than 14.3 years, and the LV posterior wall thickness to end-diastolic dimension ratio <0.14. Sex, ethnicity, cause of DCM, and family history were not associated with SCD. Conclusions: The 5-year incidence rate of SCD in children with DCM is 3%. A risk stratification rule (86% sensitivity) included age at diagnosis younger than 14.3 years, LV dilation, and LV posterior wall thinning. Patients who consistently meet these criteria should be considered for implantable cardioverter-defibrillator placement. (Pediatric Cardiomyopathy Registry; NCT00005391)

AB - Objectives: The purpose of this study was to establish the incidence of and risk factors for sudden cardiac death (SCD) in pediatric dilated cardiomyopathy (DCM). Background: The incidence of SCD in children with DCM is unknown. The ability to predict patients at high risk of SCD will help to define who may benefit most from implantable cardioverter-defibrillators. Methods: The cohort was 1,803 children in the PCMR (Pediatric Cardiomyopathy Registry) with a diagnosis of DCM from 1990 to 2009. Cumulative incidence competing-risks event rates were estimated. We achieved risk stratification using Classification and Regression Tree methodology. Results: The 5-year incidence rates were 29% for heart transplantation, 12.1% non-SCD, 4.0% death from unknown cause, and 2.4% for SCD. Of 280 deaths, 35 were SCD, and the cause was unknown for 56. The 5-year incidence rate for SCD incorporating a subset of the unknown deaths is 3%. Patients receiving antiarrhythmic medication were at higher risk of SCD (hazard ratio: 3.0, 95% confidence interval: 1.1 to 8.3, p = 0.025). A risk stratification model based on most recent echocardiographic values had 86% sensitivity and 57% specificity. Thirty of 35 SCDs occurred in patients who met all these criteria: left ventricular (LV) end-systolic dimension z-score >2.6, age at diagnosis younger than 14.3 years, and the LV posterior wall thickness to end-diastolic dimension ratio <0.14. Sex, ethnicity, cause of DCM, and family history were not associated with SCD. Conclusions: The 5-year incidence rate of SCD in children with DCM is 3%. A risk stratification rule (86% sensitivity) included age at diagnosis younger than 14.3 years, LV dilation, and LV posterior wall thinning. Patients who consistently meet these criteria should be considered for implantable cardioverter-defibrillator placement. (Pediatric Cardiomyopathy Registry; NCT00005391)

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KW - heart failure

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