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Norrish G, Qu C, Field E, Cervi E, Khraiche D, Klaassen S, Ojala TH, Sinagra G, Yamazawa H, Marrone C, Popoiu A, Centeno F, Schouvey S, Olivotto I, Day SM, Colan S, Rossano J, Wittekind SG, Saberi S, Russell M, Helms A, Ingles J, Semsarian C, Elliott PM, Ho CY, Omar RZ, Kaski JP. External validation of the HCM Risk-Kids model for predicting sudden cardiac death in childhood hypertrophic cardiomyopathy. Eur J Prev Cardiol 2022; 29:678-686. [PMID: 34718528 PMCID: PMC8967478 DOI: 10.1093/eurjpc/zwab181] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/22/2021] [Indexed: 11/24/2022]
Abstract
AIMS Sudden cardiac death (SCD) is the most common mode of death in childhood hypertrophic cardiomyopathy (HCM). The newly developed HCM Risk-Kids model provides clinicians with individualized estimates of risk. The aim of this study was to externally validate the model in a large independent, multi-centre patient cohort. METHODS AND RESULTS A retrospective, longitudinal cohort of 421 patients diagnosed with HCM aged 1-16 years independent of the HCM Risk-Kids development and internal validation cohort was studied. Data on HCM Risk-Kids predictor variables (unexplained syncope, non-sustained ventricular tachycardia, maximal left ventricular wall thickness, left atrial diameter, and left ventricular outflow tract gradient) were collected from the time of baseline clinical evaluation. The performance of the HCM Risk-Kids model in predicting risk at 5 years was assessed. Twenty-three patients (5.4%) met the SCD end-point within 5 years, with an overall incidence rate of 2.03 per 100 patient-years [95% confidence interval (CI) 1.48-2.78]. Model validation showed a Harrell's C-index of 0.745 (95% CI 0.52-0.97) and Uno's C-index 0.714 (95% 0.58-0.85) with a calibration slope of 1.15 (95% 0.51-1.80). A 5-year predicted risk threshold of ≥6% identified 17 (73.9%) SCD events with a corresponding C-statistic of 0.702 (95% CI 0.60-0.81). CONCLUSIONS This study reports the first external validation of the HCM Risk-Kids model in a large and geographically diverse patient population. A 5-year predicted risk of ≥6% identified over 70% of events, confirming that HCM Risk-Kids provides a method for individualized risk predictions and shared decision-making in children with HCM.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Chen Qu
- Department of Statistical Science, University College London, London, UK
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | | | - Sabine Klaassen
- Department of Paediatric Cardiology, Charite – Universitatsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Centre (ECRC), a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Centre for Molecular Medicine (MDC), Charite – Universitatsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Tiina H Ojala
- Department of Paediatric Cardiology, New Children’s Hospital, University of Helsinki, Helsinki, Finland
| | - Gianfranco Sinagra
- Heart Muscle Disease Registry Trieste, University of Trieste, Trieste, Italy
| | - Hirokuni Yamazawa
- Department of Paediatrics, Faculty of Medicine and Graduate school of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | - Anca Popoiu
- Department of Paediatrics, Children’s Hospital ‘Louis Turcanu’, University of Medicine and Pharmacy “Victor Babes” Timisoara, Timisoara, Romania
| | | | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Sharlene M Day
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steve Colan
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph Rossano
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samuel G Wittekind
- Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, OH, USA
| | - Sara Saberi
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Mark Russell
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Adam Helms
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Jodie Ingles
- Cardio Genomics Program at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Sydney, Australia
| | - Perry M Elliott
- Institute of Cardiovascular Sciences, University College London, London, UK
- St Bartholomew’s Centre for Inherited Cardiovascular Diseases, St Bartholomew’s Hospital, West Smithfield, London, UK
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Rumana Z Omar
- Department of Statistical Science, University College London, London, UK
| | - Juan P Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
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