Risk stratification of sudden cardiac death in young patients without structural heart disease
Risk stratification of sudden cardiac death in young patients without structural heart disease
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Original abstract
Aim. To stratify the risk of recurrent syncope and the risk of sudden cardiac death (SCD) / sudden cardiac arrest in young patients with cardiogenic syncope without structural heart disease using the Evaluation of Guidelines in Syncope Study (EGSYS score). To conduct the first retrospective analysis of the personalized risk of sudden cardiac death, as well as the sensitivity of the EGSYS scale for patients with different nosological entities. Methods . The study included 63 patients with syncope aged 18 to 44 years, the average age of the patients was 25,98±6,69 years. The patients were divided into 5 groups: the first group (12 patients, average age: 21,84±4,37 years) consisted of patients with cardiac channelopathies, the second group (16 patients, average age 25,84±6,56 years) consisted of patients with sinus node dysfunction in the form of arrest of the Kiss-Fleck node, the third group consisted of patients with atrioventricular block (15 patients, the average age 26,71±7,13 years), the fourth group consisted of patients with paroxysmal monomorphic and polymorphic ventricular tachycardia (15 patients, the average age of the group was 25,74±7,79 years), the fifth group consisted of patients with syncope in the Wolff-Parkinson-White (WPW) syndrome (5 patients, average age - 25,64±3,05 years). The frequency of recurrence of syncope and SCD episodes was assessed over a 2-year period from the time of the first syncope. The EGSYS score was used to stratify the risk of recurrence of syncope and SCD. Results : A total of 23 patients, or 36.5% of the study population, had an EGSYS score more than 5 points (very high), with a 2-year risk of SCD of 21% and a risk of recurrent syncope of 77%. In addition, the highest score on the EGSYS scale was associated with a higher frequency of cardiogenic syncope and SCD episodes. Patients with cardiac channelopathies had the highest EGSYS score (mean score 5.84), which was associated with the highest incidence of syncope and episodes of SCD with cardiopulmonary resuscitation over a 2-year period (r=0,58, p=0,01). The risk of developing SCD over a 2-year period in the group of patients with sinus node dysfunction (sinus node arrest) does not exceed the average population (less than 2%), which was associated with the absence of episodes of sudden cardiac death (sudden cardiac arrest) for a period of 2 years in the patients in this group. The highest validation of the EGSYS score and the frequency of syncope over a 2-year period were in patients with ventricular tachycardia ((r=0,73, р=0,002). Conclusion : Thus, already at the debut syncopal state there is a possibility of determining the personalized risk of recurrent syncope and sudden cardiac death using the EGSYS scale. According to the study, the area of the highest sensitivity of the scale was patients with ventricular tachycardia (the main cause of SCD), which allows us to consider this scale as a basis for constructing a prognostic model for stratifying the risk of sudden cardiac death in young patients with cardiogenic syncope without structural heart disease.