Timing of cardioverter-defibrillator implantation in patients with cardiac laminopathies — External validation of the LMNA-risk ventricular tachyarrhythmia calculator

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  • Christine Rootwelt-Norberg
  • Christensen, Alex Hørby
  • Eystein T. Skjølsvik
  • Monica Chivulescu
  • Christoffer R. Vissing
  • Bundgård, Henning
  • Eivind W. Aabel
  • Martin P. Bogsrud
  • Nina E. Hasselberg
  • Øyvind H. Lie
  • Kristina H. Haugaa

Background: LMNA genotype-positive patients have high risk of experiencing life-threatening ventricular tachyarrhythmias (VTAs). The LMNA-risk VTA calculator published in 2019 has not been externally validated. Objective: The purpose of this study was to validate the LMNA-risk VTA calculator. Methods: We included LMNA genotype-positive patients without previous VTAs from 2 large Scandinavian centers. Patients underwent electrocardiography, 24-hour Holter monitoring, and echocardiographic examinations at baseline and repeatedly during follow-up. Validation of the LMNA-risk VTA calculator was performed using Harrell's C-statistic derived from multivariable Cox regression analysis. Results: We included 118 patients (age 37 years [IQR 27–49 years]; 39 [33%] probands; 65 [55%] women; 100 [85%] with non-missense LMNA variants). Twenty-three patients (19%) experienced VTA during 6.1 years (interquartile range 3.0–9.1 years) follow-up, resulting in 3.0% (95% confidence interval 2.0%–4.5%) yearly incidence rate. Atrioventricular block and reduced left ventricular ejection fraction were independent predictors of VTAs, while nonsustained ventricular tachycardia, male sex, and non-missense LMNA variants were not. The LMNA-risk VTA calculator showed 83% sensitivity and 26% specificity for identifying patients with VTAs during the coming 5 years, and a Harrell's C-statistic of 0.85, when applying ≥7% predicted 5-year VTA risk as threshold. The sensitivity increased to 100% when reevaluating risk at the time of last consultation before VTA. The calculator overestimated arrhythmic risk in patients with mild and moderate phenotype, particularly in men. Conclusion: Validation of the LMNA-risk VTA calculator showed high sensitivity for subsequent VTAs, but overestimated arrhythmic risk when using ≥7% predicted 5-year risk as threshold. Frequent reevaluation of risk was necessary to maintain the sensitivity of the model.

Original languageEnglish
JournalHeart Rhythm
Volume20
Issue number3
Pages (from-to)423-429
ISSN1547-5271
DOIs
Publication statusPublished - 2023

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© 2022 Heart Rhythm Society

    Research areas

  • Lamin A/C, Laminopathy, LMNA cardiomyopathy, LMNA-risk VTA calculator, Primary preventive ICD, Ventricular tachyarrhythmia

ID: 334302518