致心律失常性右室心肌病风险预测模型在中国队列中的验证
Validation of an Arrhythmogenic Right Ventricular Cardiomyopathy Risk-Prediction Model in a Chinese Cohort.
作者信息
Zhang Nixiao, Wang Chuangshi, Gasperetti Alessio, Song Yanyan, Niu Hongxia, Gu Min, Duru Firat, Chen Liang, Zhang Shu, Hua Wei
机构信息
Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
出版信息
J Clin Med. 2022 Apr 1;11(7):1973. doi: 10.3390/jcm11071973.
BACKGROUND
The novel arrhythmogenic right ventricular cardiomyopathy (ARVC)-associated ventricular arrhythmias (VAs) risk-prediction model endorsed by Cadrin-Tourigny et al. was recently developed to estimate visual VA risk and was identified to be more effective for predicting ventricular events than the International Task Force Consensus (ITFC) criteria, and the Heart Rhythm Society (HRS) criteria. Data regarding its application in Asians are lacking.
OBJECTIVES
We aimed to perform an external validation of this algorithm in the Chinese ARVC population.
METHODS
The study enrolled 88 ARVC patients who received implantable cardioverter-defibrillator (ICD) from January 2005 to January 2020. The primary endpoint was appropriate ICD therapies. The novel prediction model was used to calculate a priori predicted VA risk that was compared with the observed rates.
RESULTS
During a median follow-up of 3.9 years, 57 (64.8%) patients received the ICD therapy. Patients with implanted ICDs for primary prevention had non-significantly lower rates of ICD therapy than secondary prevention (5-year event rate: 0.46 (0.13-0.66) and 0.80 (0.64-0.89); log-rank = 0.098). The validation study revealed the C-statistic of 0.833 (95% confidence interval (CI) 0.615-1.000), and the predicted and the observed patterns were similar in primary prevention patients (mean predicted-observed risk: -0.07 (95% CI -0.21, 0.09)). However, in secondary prevention patients, the C-statistic was 0.640 (95% CI 0.510-0.770) and the predicted risk was significantly underestimated (mean predicted-observed risk: -0.32 (95% CI -0.39, -0.24)). The recalibration analysis showed that the performance of the prediction model in secondary prevention patients was improved, with the mean predicted-observed risk of -0.04 (95% CI -0.10, 0.03).
CONCLUSIONS
The novel risk-prediction model had a good fitness to predict arrhythmic risk in Asian ARVC patients for primary prevention, and for secondary prevention patients after recalibration of the baseline risk.
背景
Cadrin-Tourigny等人认可的新型致心律失常性右室心肌病（ARVC）相关室性心律失常（VA）风险预测模型最近被开发出来，用于估计视觉VA风险，并且被确定在预测心室事件方面比国际工作组共识（ITFC）标准和心律学会（HRS）标准更有效。缺乏关于其在亚洲人应用的数据。
目的
我们旨在对该算法在中国ARVC人群中进行外部验证。
方法
该研究纳入了2005年1月至2020年1月期间接受植入式心律转复除颤器（ICD）的88例ARVC患者。主要终点是适当的ICD治疗。使用新型预测模型计算先验预测的VA风险，并与观察到的发生率进行比较。
结果
在中位随访3.9年期间，57例（64.8%）患者接受了ICD治疗。因一级预防植入ICD的患者接受ICD治疗的发生率略低于二级预防患者（5年事件发生率：0.46（0.13 - 0.66）和0.80（0.64 - 0.89）；对数秩检验 = 0.098）。验证研究显示C统计量为0.833（95%置信区间（CI）0.615 - 1.000），在一级预防患者中预测模式与观察模式相似（平均预测 - 观察风险：-0.07（95% CI -0.21，0.09））。然而，在二级预防患者中，C统计量为0.640（95% CI 0.510 - 0.770），预测风险被显著低估（平均预测 - 观察风险：-0.32（95% CI -0.39，-0.24））。重新校准分析表明，预测模型在二级预防患者中的性能得到改善，平均预测 - 观察风险为-0.04（95% CI -0.10，0.03）。
结论
新型风险预测模型在预测亚洲ARVC患者一级预防和基线风险重新校准后的二级预防心律失常风险方面具有良好的拟合度。
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