1
|
Boleti OD, Roussos S, Norrish G, Field E, Oates S, Tollit J, Nepali G, Bhole V, Uzun O, Daubeney PEF, Stuart GA, Fernandes P, McLeod K, Ilina M, Liaqath MNA, Bharucha T, Delle Donne G, Brown E, Linter K, Khodaghalian B, Jones C, Searle J, Mathur S, Boyd N, Reindhardt Z, Duignan S, Prendiville T, Adwani S, Zenker M, Wolf CM, Kaski JP. Sudden cardiac death in childhood RASopathy-associated hypertrophic cardiomyopathy: Validation of the HCM risk-kids model and predictors of events. Int J Cardiol 2023; 393:131405. [PMID: 37777071 DOI: 10.1016/j.ijcard.2023.131405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/09/2023] [Accepted: 09/27/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND RASopathies account for nearly 20% of cases of childhood hypertrophic cardiomyopathy (HCM). Sudden cardiac death (SCD) occurs in patients with RASopathy-associated HCM, but the risk factors for SCD have not been systematically evaluated. AIM To validate the HCM Risk-Kids SCD risk prediction model in children with RASopathy-associated HCM and investigate potential specific SCD predictors in this population. METHODS Validation of HCM Risk-Kids was performed in a retrospective cohort of 169 patients with a RASopathy-associated HCM from 15 international paediatric cardiology centres. Multiple imputation by chained equations was used for missing values related to the HCM Risk-Kids parameters. RESULTS Eleven patients (6.5%) experienced a SCD or equivalent event at a median age of 12.5 months (IQR 7.7-28.64). The calculated SCD/equivalent event incidence was 0.78 (95% CI 0.43-1.41) per 100 patient years. Six patients (54.54%) with an event were in the low-risk category according to the HCM Risk-Kids model. Harrell's C index was 0.60, with a sensitivity of 9.09%, specificity of 63.92%, positive predictive value of 1.72%, and negative predictive value of 91%; with a poor distinction between the different risk groups. Unexplained syncope (HR 42.17, 95% CI 10.49-169.56, p < 0.001) and non-sustained ventricular tachycardia (HR 5.48, 95% CI 1.58-19.03, p < 0.007) were predictors of SCD on univariate analysis. CONCLUSION Unexplained syncope and the presence of NSVT emerge as predictors for SCD in children with RASopathy-associated HCM. The HCM Risk-Kids model may not be appropriate to use in this population, but larger multicentre collaborative studies are required to investigate this further.
Collapse
Affiliation(s)
- Olga D Boleti
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gabrielle Norrish
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Ella Field
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Stephanie Oates
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Jennifer Tollit
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Gauri Nepali
- The Heart Unit, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Vinay Bhole
- The Heart Unit, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Orhan Uzun
- Children's Heart Unit, University Hospital of Wales, Cardiff, United Kingdom
| | - Piers E F Daubeney
- Department of Paediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Graham A Stuart
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Precylia Fernandes
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Karen McLeod
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Maria Ilina
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | | | - Tara Bharucha
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, United Kingdom
| | - Grazia Delle Donne
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Elspeth Brown
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Katie Linter
- Department of Paediatric Cardiology, Glenfield Hospital, Leicester, United Kingdom
| | - Bernadette Khodaghalian
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK; Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Caroline Jones
- Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Jonathan Searle
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK; Department of Paediatric Cardiology, John Radcliffe Hospital, Oxford, United Kingdom; Children's Heart Service, Evelina Children's Hospital, London, United Kingdom
| | - Sujeev Mathur
- Children's Heart Service, Evelina Children's Hospital, London, United Kingdom
| | - Nicola Boyd
- Department of Paediatric Cardiology, The Freeman Hospital, Newcastle, United Kingdom
| | - Zdenka Reindhardt
- Department of Paediatric Cardiology, The Freeman Hospital, Newcastle, United Kingdom
| | - Sophie Duignan
- The Children's Heart Centre, Our Lady's Children's Hospital, Dublin, Ireland
| | - Terence Prendiville
- The Children's Heart Centre, Our Lady's Children's Hospital, Dublin, Ireland
| | - Satish Adwani
- Department of Paediatric Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Martin Zenker
- Institute of Human Genetics, University Hospital, Magdeburg, Germany
| | - Cordula Maria Wolf
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Juan Pablo Kaski
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK.
| |
Collapse
|