Sudden cardiac death screening
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Sudden cardiac death Microchapters |
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Diagnosis |
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Sudden cardiac death screening On the Web |
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American Roentgen Ray Society Images of Sudden cardiac death screening |
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Risk calculators and risk factors for Sudden cardiac death screening |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Edzel Lorraine Co, DMD, MD[3] Nehal Eid, M.D.[4]
Overview
- Several risk calculators specific for sudden cardiac death (SCD) were proposed in all age groups [1] [2] [3] [4] [5].
- These tools can be of great help in distinguishing patients who are at high risk for this condition.
Screening
- If the phenotype in a patient resuscitated after sudden cardiac arrest is established, a recent expert consensus statement[6] recommends genetic testing focused on potential candidate genes and clinical evaluation of family members to identify relatives who have or are at risk of developing a clinical condition.
- If the cause of sudden cardiac arrest is not determined, first-degree relatives may undergo clinical evaluation, including ECG, cardiac imaging, ambulatory monitoring, and provocative testing.
- Psychological evaluation and treatment of grief and post traumatic stress in survivors and their immediate family members by trained mental health professionals is recommended.[6]
- Several SCD risk calculators are available for all age groups [1] [2] [3] [4] [5]
- HCM Risk-Kids Score is a validated risk calculator used for patients with hypertrophic cardiomyopathy (HCM) who are up to 16 years of age.
- LQTS Risk Calculator
- VA calculator
Screening in young athletes:
The American Heart Association–American College of Cardiology consensus statement[7] on preparticipation screening recommends the American Heart Association 14-point screening guide, including a comprehensive history taking and a physical examination for young athletes (class I recommendation), but does not recommend routine ECG screening of young adults (athletes and non-athletes) in the general population (class III), due to concerns about diagnostic accuracy, cost-effectiveness, and availability of physicians and equipment needed for screening. ECG or transthoracic echocardiography should only be performed in select individuals in whom genetic,congenital,or other cardiovascular abnormalities are suspected or identified (class IIb).[7]
However, recent ESC guideline recommends a 12-lead ECG as part of preparticipation for all competitive athletes younger than 35 years (class IIa).[8] This recommendation was supported by outcome data from the Veneto region, which showed declining incidence of sudden death in young competitive athletes after introduction of a nationwide prescreening program using ECG.[9] Some data suggest that compared with history and physical examination, ECG may provide superior accuracy to identify potential risk of sudden death, primarily due to detection of preexcitation syndromes (sensitivity 88% vs 19%, specificity 98% vs 75%).[10],[11]
In the last 2 decades, preparticipation screening for early identification of young competitive athletes at risk of sudden cardiac arrest in high school, college, and professional settings has been investigated. A comparable incidence of cardiovascular deaths was found between 1993 and 2015 in these studies screening competitive athletes. In the Veneto region of Italy, where ECG is routinely employed as part of preparticipation screening, and those in the US (Minnesota), where preparticipation prescreening is limited to history and physical examination.[12]
2022 ESC Guidelines for the management of patients with ventricular arrythymias and the prevention of sudden cardiac death [8]
| Recommendations for evaluation of relatives of sudden arrhythmic death syndrome decedents |
| Class I (Level of Evidence: B) |
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References
- ↑ 1.0 1.1 Wahbi K, Ben Yaou R, Gandjbakhch E, Anselme F, Gossios T, Lakdawala NK; et al. (2019). "Development and Validation of a New Risk Prediction Score for Life-Threatening Ventricular Tachyarrhythmias in Laminopathies". Circulation. 140 (4): 293–302. doi:10.1161/CIRCULATIONAHA.118.039410. PMID 31155932.
- ↑ 2.0 2.1 Cadrin-Tourigny J, Bosman LP, Nozza A, Wang W, Tadros R, Bhonsale A; et al. (2019). "A new prediction model for ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy". Eur Heart J. 40 (23): 1850–1858. doi:10.1093/eurheartj/ehz103. PMC 6568197 Check
|pmc=value (help). PMID 30915475. - ↑ 3.0 3.1 Miron A, Lafreniere-Roula M, Steve Fan CP, Armstrong KR, Dragulescu A, Papaz T; et al. (2020). "A Validated Model for Sudden Cardiac Death Risk Prediction in Pediatric Hypertrophic Cardiomyopathy". Circulation. 142 (3): 217–229. doi:10.1161/CIRCULATIONAHA.120.047235. PMC 7365676 Check
|pmc=value (help). PMID 32418493 Check|pmid=value (help). - ↑ 4.0 4.1 Norrish G, Ding T, Field E, Ziólkowska L, Olivotto I, Limongelli G; et al. (2019). "Development of a Novel Risk Prediction Model for Sudden Cardiac Death in Childhood Hypertrophic Cardiomyopathy (HCM Risk-Kids)". JAMA Cardiol. 4 (9): 918–927. doi:10.1001/jamacardio.2019.2861. PMC 6694401 Check
|pmc=value (help). PMID 31411652. - ↑ 5.0 5.1 O'Mahony C, Jichi F, Pavlou M, Monserrat L, Anastasakis A, Rapezzi C; et al. (2014). "A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM risk-SCD)". Eur Heart J. 35 (30): 2010–20. doi:10.1093/eurheartj/eht439. PMID 24126876.
- ↑ 6.0 6.1 Stiles MK, Wilde AAM, Abrams DJ, et al. 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families. Heart Rhythm. 2021;18(1):e1-e50. doi:10.1016/j.hrthm.2020.10.010
- ↑ 7.0 7.1 Maron BJ, Levine BD, Washington RL, Baggish AL, Kovacs RJ, Maron MS; American Heart Association Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 2: preparticipation screening for cardiovascular disease in competitive athletes: a scientific statement from the American Heart Association and AmericanCollege of Cardiology. Circulation. 2015;132(22):e267-e272.
- ↑ 8.0 8.1 Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA; et al. (2022). "2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death". Eur Heart J. 43 (40): 3997–4126. doi:10.1093/eurheartj/ehac262. PMID 36017572 Check
|pmid=value (help). - ↑ Corrado D, Basso C, Pavei A, Michieli P, Schiavon M,ThieneG. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA.2006;296(13):1593-1601. doi:10.1001/jama.296.13.1593
- ↑ Williams EA, Pelto HF, Toresdahl BG, et al. Performance of the American Heart Association (AHA)14-point evaluation versus electrocardiography for the cardiovascular screening of high school athletes: a prospective 996 study. J AmHeartAssoc.2019;8(14):e012235. doi:10.1161/JAHA.119.012235
- ↑ Goff NK, Hutchinson A, Koek W, Kamat D. Meta-analysis on the effectiveness of ECG screening for conditions related to sudden cardiac death in young athletes. Clin Pediatr (Phila). 2023;62(10):1158-1168. doi:10.1177/ 00099228231152857
- ↑ Maron BJ, Haas TS, Doerer JJ, Thompson PD, Hodges JS. Comparison of U.S.and Italian experiences with sudden cardiac deaths in young competitive athletes and implications for preparticipation screening strategies. Am J Cardiol. 2009;104(2):276-280. doi:10.1016/j.amjcard.2009. 03.037