Relationship Between Maximal Left Ventricular Wall Thickness and Sudden Cardiac Death in Childhood Onset Hypertrophic Cardiomyopathy

Author:

Norrish Gabrielle12,Ding Tao3,Field Ella1ORCID,Cervi Elena1ORCID,Ziółkowska Lidia4ORCID,Olivotto Iacopo5ORCID,Khraiche Diala6,Limongelli Giuseppe7ORCID,Anastasakis Aris8,Weintraub Robert9ORCID,Biagini Elena10ORCID,Ragni Luca10,Prendiville Terrence11ORCID,Duignan Sophie12ORCID,McLeod Karen12,Ilina Maria12ORCID,Fernández Adrián13ORCID,Marrone Chiara14,Bökenkamp Regina15,Baban Anwar16ORCID,Kubus Peter17,Daubeney Piers E.F.18,Sarquella-Brugada Georgia19ORCID,Cesar Sergi19ORCID,Klaassen Sabine202122ORCID,Ojala Tiina H.23ORCID,Bhole Vinay24,Medrano Constancio2526ORCID,Uzun Orhan27ORCID,Brown Elspeth28ORCID,Gran Ferran29ORCID,Sinagra Gianfranco30ORCID,Castro Francisco J.31ORCID,Stuart Graham32ORCID,Vignati Gabriele33ORCID,Yamazawa Hirokuni34ORCID,Barriales-Villa Roberto35ORCID,Garcia-Guereta Luis36ORCID,Adwani Satish37ORCID,Linter Katie38,Bharucha Tara39ORCID,Garcia-Pavia Pablo40,Siles Ana40ORCID,Rasmussen Torsten B.41ORCID,Calcagnino Margherita42ORCID,Jones Caroline B.43ORCID,De Wilde Hans44ORCID,Kubo Toru45ORCID,Felice Tiziana46ORCID,Popoiu Anca47ORCID,Mogensen Jens48ORCID,Mathur Sujeev49,Centeno Fernando50ORCID,Reinhardt Zdenka51ORCID,Schouvey Sylvie52,O’Mahony Costas253,Omar Rumana Z.3ORCID,Elliott Perry M.253ORCID,Kaski Juan Pablo12ORCID

Affiliation:

1. Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.).

2. Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom.

3. Department of Statistical Science (T.D., R.Z.O.), University College London, United Kingdom.

4. The Children’s Memorial Health Institute, Warsaw, Poland (L.Z.).

5. Careggi University Hopsital, Florence, Italy (I.O.).

6. Necker–Enfants Malades Hospital, Paris, France (D.K.).

7. Monaldi Hospital, Naples, Italy (G.L.).

8. Onassis Cardiac Surgery Center, Athens, Greece (A.A.).

9. Royal Children’s Hospital, Melbourne, Australia (R.W.).

10. Cardiology Unit, S. Orsola-Malpighi Hospital, IRCCS Azienda Ospedalierao-Universitaria di Bologna, Italy (E.B., L.R.).

11. Our Lady’s Children’s Hospital, Dublin, Ireland (T.P., S.D.).

12. Royal Hospital for Children, Glasgow, United Kingdom (K.M., M.I.).

13. Fundación Favaloro University Hospital, Buenos Aires, Argentina (A.F.).

14. Papa Giovanni XXIII Hospital, Bergamo (C.M.).

15. Leiden University Medical Center, the Netherlands (R.B.).

16. Bambino Gesu Hospital, Rome, Italy (A.B.).

17. University Hospital Motol, Prague, Czech Republic (P.K.).

18. Royal Brompton and Harefield NHS Trust, London, United Kingdom (P.E.F.D.).

19. Sant Joan de Deu, Barcelona, Spain (G.S.-B., S.C.).

20. Department of Pediatric Cardiology (S.K.), Charite–Universitatsmedizin Berlin, Germany.

21. Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Center for Molecular Medicine (S.K.), Charite–Universitatsmedizin Berlin, Germany.

22. German Centre for Cardiovascular Research, Partner Site Berlin, Germany (S.K.).

23. Department of Pediatric Cardiology, Pediatric Research Center, New Children’s Hospital, University of Helsinki, Finland (T.H.O.).

24. Birmingham Children’s Hospital, United Kingdom (V.B.).

25. Fondazione Toscana G. Monasterio, Massa-Pisa, Italy (C.M.).

26. Hospital General Universitario Gregorio Marañón, Madrid, Spain (C.M.).

27. University Hospital of Wales, Cardiff (O.U.).

28. Leeds General Infirmary, United Kingdom (E.B.).

29. Val d’Hebron University Hospital, Barcelona, Spain (F.G.).

30. Heart Muscle Disease Registry Trieste, University of Trieste, Italy (G.S.).

31. University Hospital Virgen de la Arrixaca, Murcia, Spain (F.J.C.).

32. Bristol Royal Hospital for Children, United Kingdom (G.S.).

33. Niguarda Hospital, Milan, Italy (G.V.).

34. Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, Sapporo, Japan (H.Y.).

35. Complexo Hospitalario Universitario A Coruna, INIBIC, CIBERCV, Spain (R.B.-V.).

36. University Hospital La Paz, Madrid, Spain (L.G.-G.).

37. John Radcliffe Hospital, Oxford (S.A.).

38. Glenfield Hospital, Leicester (K.L.).

39. Southampton General Hospital, Southampton, United Kingdom (T.B.).

40. Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (P.G.-P., A.S.).

41. Aarhus University Hospital, Denmark (T.B.R.).

42. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Dept di Medicina Interna, UOC Cardiologica, Milano, Italy (M.C.).

43. Alder Hey Children’s Hospital, Liverpool, United Kingdom (C.B.J.).

44. Ghent University Hospital, Belgium (H.D.W.).

45. Kochi Medical School Hospital, Japan (T.K.).

46. Mater Dei Hospital, Malta (T.F.).

47. Department of Pediatrics, University of Medicine and Pharmacy “Victor Babes” Timisoara, Children’s Hospital ‘Louis Turcanu,’ Romania (A.P.).

48. Aalborg University Hospital, Denmark (J.M.).

49. Evelina Children’s Hospital, London, United Kingdom (S.M.).

50. Rio Hortega University Hospital, Valladolid, Spain (F.C.).

51. The Freeman Hospital, Newcastle, United Kingdom (Z.R.).

52. Hospital Saint Joseph, Marseille, France (S.S.).

53. St Bartholomew’s Centre for Inherited Cardiovascular Diseases, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom (C.O., P.M.E.).

Abstract

Background: Maximal left ventricular wall thickness (MLVWT) is a risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). In adults, the severity of left ventricular hypertrophy has a nonlinear relationship with SCD, but it is not known whether the same complex relationship is seen in childhood. The aim of this study was to describe the relationship between left ventricular hypertrophy and SCD risk in a large international pediatric HCM cohort. Methods: The study cohort comprised 1075 children (mean age, 10.2 years [±4.4]) diagnosed with HCM (1–16 years) from the International Paediatric Hypertrophic Cardiomyopathy Consortium. Anonymized, noninvasive clinical data were collected from baseline evaluation and follow-up, and 5-year estimated SCD risk was calculated (HCM Risk-Kids). Results: MLVWT Z score was <10 in 598 (58.1%), ≥10 to <20 in 334 (31.1%), and ≥20 in 143 (13.3%). Higher MLVWT Z scores were associated with heart failure symptoms, unexplained syncope, left ventricular outflow tract obstruction, left atrial dilatation, and nonsustained ventricular tachycardia. One hundred twenty-two patients (71.3%) with MLVWT Z score ≥20 had coexisting risk factors for SCD. Over a median follow-up of 4.9 years (interquartile range, 2.3–9.3), 115 (10.7%) had an SCD event. Freedom from SCD event at 5 years for those with MLVWT Z scores <10, ≥10 to <20, and ≥20 was 95.6%, 87.4%, and 86.0, respectively. The estimated SCD risk at 5 years had a nonlinear, inverted U-shaped relationship with MLVWT Z score, peaking at Z score +23. The presence of coexisting risk factors had a summative effect on risk. Conclusions: In children with HCM, an inverted U-shaped relationship exists between left ventricular hypertrophy and estimated SCD risk. The presence of additional risk factors has a summative effect on risk. While MLVWT is important for risk stratification, it should not be used either as a binary variable or in isolation to guide implantable cardioverter defibrillator implantation decisions in children with HCM.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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