Project Details
Description
Background
Implantable cardioverter defibrillators have been a hallmark discovery for the management of VA in individuals at increased risk for sudden cardiac death (SCD). Patient selection for ICD implantation is crucial. There is little debate regarding treatment options for those who have survived cardiac arrest, as they are unequivocally offered ICD therapy 1. Current guidelines for ICD implantation as a primary preventive measure for SCD include: left ventricular ejection fraction (LVEF) ≤ 35% despite at least three months of optimal medical therapy, New York Heart Association (NYHA) classification of heart failure (Class II to III symptoms), and a reasonable expectation of meaningful survival for more than one year 1.
It is considered an "epidemiological paradox" that a large proportion of SCD cases occur in individuals not considered high-risk. Indicators associated with an increased risk of SCD from arrhythmias include conventional coronary risk factors, as the majority of SCDs have coronary heart disease as the underlying condition 2. These are powerful risk markers at the population level 2, however the value of conventional cardiovascular risk markers to predict fatal arrhythmic events in individual subjects is low. Therefore, a search for more specific markers to predict fatal arrhythmias leading to SCD is needed. Identifying “the risk patient in the general population, where potentially life-saving interventions like ICD implantation can occur, is vital 3.
Clinically relevant coronary artery disease or heart failure could modify the effects of other risk factors and interact with the decision to implant an ICD. Semi-quantitative data characterizing the presence of clinically relevant coronary stenosis or reduced ejection fraction are needed. Comparing the effect of risk factors on the decision to implant ICDs in those with and without these traits is essential.
As SCD is the end result of a variety of processes and mechanisms, a search for a multimarker strategy for SCD prediction is needed. Multivariable risk algorithms for SCD have been proposed as no single test can identify all patients at risk of SCD 4. By assessing earlier life risk markers predictive of ICD implantation rather than for SCD, we can identify risk markers that can be used to risk stratify subjects in the general population who are “at risk” of ICD implantation for either primary or secondary intervention.
Purpose and Aims
We aim to study risk factors from the general population that are associated with ICD implantation later on in life, which will help in our understanding of identifying subjects who would benefit from ICD implantation. Three population based cohort studies will be used: Malmö Diet and Cancer Study (MDCS), Malmö Preventive Project (MPP) and the Swedish CArdioPulmonary bioImage Study (SCAPIS).
Work plan
The study requires linkage between the respective cohort studies (MDCS, MPP, SCAPIS) and the Swedish Pacemaker and ICD and SWEDEHEART registers. Follow-up data is available from baseline for all three cohorts (up to 31 years for MDCS, 48 years for MPP, and 8 years for SCAPIS). Data from MDCS, MPP, and the Swedish Pacemaker and ICD registries have already been received.
Clinical significance
Identifying measurable risk markers for future ICD implantation in the general population will provide vital knowledge on the early-life risk profile associated with ICD implantation. This can be used to create a risk score to identify high-risk individuals earlier in life when managing risk factors may alter the long-term risk of ICD implantation.
References
1. Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. European heart journal. 2021;42(35):3427-520.
2. Adabag AS, Luepker RV, Roger VL, Gersh BJ. Sudden cardiac death: epidemiology and risk factors. Nat Rev Cardiol. 2010;7(4):216-25.
3. Huikuri HV, Castellanos A, Myerburg RJ. Sudden Death Due to Cardiac Arrhythmias. New England Journal of Medicine. 2001;345(20):1473-82.
4. Buxton AE. Risk stratification for sudden death in patients with coronary artery disease. Heart rhythm. 2009;6(6):836-47.
Implantable cardioverter defibrillators have been a hallmark discovery for the management of VA in individuals at increased risk for sudden cardiac death (SCD). Patient selection for ICD implantation is crucial. There is little debate regarding treatment options for those who have survived cardiac arrest, as they are unequivocally offered ICD therapy 1. Current guidelines for ICD implantation as a primary preventive measure for SCD include: left ventricular ejection fraction (LVEF) ≤ 35% despite at least three months of optimal medical therapy, New York Heart Association (NYHA) classification of heart failure (Class II to III symptoms), and a reasonable expectation of meaningful survival for more than one year 1.
It is considered an "epidemiological paradox" that a large proportion of SCD cases occur in individuals not considered high-risk. Indicators associated with an increased risk of SCD from arrhythmias include conventional coronary risk factors, as the majority of SCDs have coronary heart disease as the underlying condition 2. These are powerful risk markers at the population level 2, however the value of conventional cardiovascular risk markers to predict fatal arrhythmic events in individual subjects is low. Therefore, a search for more specific markers to predict fatal arrhythmias leading to SCD is needed. Identifying “the risk patient in the general population, where potentially life-saving interventions like ICD implantation can occur, is vital 3.
Clinically relevant coronary artery disease or heart failure could modify the effects of other risk factors and interact with the decision to implant an ICD. Semi-quantitative data characterizing the presence of clinically relevant coronary stenosis or reduced ejection fraction are needed. Comparing the effect of risk factors on the decision to implant ICDs in those with and without these traits is essential.
As SCD is the end result of a variety of processes and mechanisms, a search for a multimarker strategy for SCD prediction is needed. Multivariable risk algorithms for SCD have been proposed as no single test can identify all patients at risk of SCD 4. By assessing earlier life risk markers predictive of ICD implantation rather than for SCD, we can identify risk markers that can be used to risk stratify subjects in the general population who are “at risk” of ICD implantation for either primary or secondary intervention.
Purpose and Aims
We aim to study risk factors from the general population that are associated with ICD implantation later on in life, which will help in our understanding of identifying subjects who would benefit from ICD implantation. Three population based cohort studies will be used: Malmö Diet and Cancer Study (MDCS), Malmö Preventive Project (MPP) and the Swedish CArdioPulmonary bioImage Study (SCAPIS).
Work plan
The study requires linkage between the respective cohort studies (MDCS, MPP, SCAPIS) and the Swedish Pacemaker and ICD and SWEDEHEART registers. Follow-up data is available from baseline for all three cohorts (up to 31 years for MDCS, 48 years for MPP, and 8 years for SCAPIS). Data from MDCS, MPP, and the Swedish Pacemaker and ICD registries have already been received.
Clinical significance
Identifying measurable risk markers for future ICD implantation in the general population will provide vital knowledge on the early-life risk profile associated with ICD implantation. This can be used to create a risk score to identify high-risk individuals earlier in life when managing risk factors may alter the long-term risk of ICD implantation.
References
1. Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. European heart journal. 2021;42(35):3427-520.
2. Adabag AS, Luepker RV, Roger VL, Gersh BJ. Sudden cardiac death: epidemiology and risk factors. Nat Rev Cardiol. 2010;7(4):216-25.
3. Huikuri HV, Castellanos A, Myerburg RJ. Sudden Death Due to Cardiac Arrhythmias. New England Journal of Medicine. 2001;345(20):1473-82.
4. Buxton AE. Risk stratification for sudden death in patients with coronary artery disease. Heart rhythm. 2009;6(6):836-47.
| Status | Active |
|---|---|
| Effective start/end date | 2024/10/21 → 2026/08/31 |
Funding
- Märta Winklers stiftelse för främjande av medicinsk forskning