Sudden death Scope of the problem and risk stratification INSERM U970 Cardiovascular epidemiology and sudden death Pr Xavier JOUVEN.

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Presentation transcript:

Sudden death Scope of the problem and risk stratification INSERM U970 Cardiovascular epidemiology and sudden death Pr Xavier JOUVEN

Nothing to declare DECLARATION OF CONFLICT OF INTEREST

Epidemiology of SCD important challenges Definition Incidence and evolution Heterogeneity of the causes Magic treshold: 35% LVEF Sport related sudden death Sudden death expertise center

Sudden Cardiac Death Prediction and Prevention Report From a National Heart, Lung, and Blood Institute and Heart Rhythm Society Workshop

Epidemiology of SCD important challenges Definition Incidence and evolution Heterogeneity of the causes Magic treshold: 35% LVEF Sport related sudden death Sudden death expertise center

major coronary events out of hospital deaths (29%) in hospital deaths (9.5%)

Mortality due to CHD in the hospital (within 28 days) and out of the hospital per population 35 to 84 years of age, 1991 to 2006

Case fatality in hospital (within 28 days) and out of hospital by 4-year period and age group among persons with a first-time coronary event, 1991 to 2006

Epidemiology of SCD important challenges Definition Incidence and evolution Heterogeneity of the causes Magic treshold: 35% LVEF Sport related sudden death Sudden death expertise center

Non Cardiac Long QT 90 % Cardiac Unknown Non ischemic 5 % Discharged alive 30 % Admitted alive Known 80 % Ischemic heart disease HCM ARVC Myocarditis 10 % Brugada 15% 5% MONDRIAN SQUARE OF SUDDEN DEATH

Risk of sudden death Myerburg et al. AJC 1987

Epidemiology of SCD important challenges Definition Incidence and evolution Heterogeneity of the causes Magic treshold: 35% LVEF Sport related sudden death Sudden death expertise center

Clinical trials : primary prevention  MADIT (1)  CABG-Patch (2)  CAT (1)  MUSTT (3)  AMIOVIRT (1)  MADIT II (1)  SCD-HeFT (4)  DINAMIT (5)  DEFINITE (5) 1- supported by Guidant 2- supported by Guidant & NHLBI 3- supported by Guidant, Medtronic, StJude/Ventritex et al. 4- Supported by NIH, Medtronic, Wyeth-Ayerst et al. 5- Supported by St Jude

Goldenberg JACC 2008

Contribution of severe LV systolic dysfunction to SCD in the general population. LVEF ≤35% is currently the risk predictor most widely used in clinical practice. However, findings from the Oregon Sudden Unexpected Death Study revealed that severe LV dysfunction affects less than one-third of all cases of SCD in the general population Oregon sudden death study

Epidemiology of SCD important challenges Definition Incidence and evolution Heterogeneity of the causes Magic treshold: 35% LVEF Sport related sudden death Sudden death expertise center

Incidence of sudden cardiac death in national collegiate athletic association athletes Circulation 2011, 5 April Harmon KG, Asif IM, Klossner D, Drezner JA True incidence of SCD in US athletes Jan : 2 millions athletes participant-year 273 deaths:187(68%) traumatic causes 45 SCD

“Young Competitive Athletes” USA : 1058 cas sur 27 ans Italie : 55 cas sur 25 ans Maron AJC 2009 Corrado JAMA 2006 Maron Circulation 2009 France : cases/year

The large majority of data regarding sports-related SD have focused on young competitive athletes. Literature on sports-related SD during recreational sports activities in the community remains sparse. Maron BJ, Circulation 2009 Corrado D, JACC 2008 Pelliccia A, NEJM 2008

Methods (1) Setting Under the auspices of the Ministère de la Jeunesse, des Sports et Subjects aged years Ongoing prospective French registry from April 2005 carried out by INSERM U970 60/96 districts (33 millions yrs inhabits) Exclusion criteria of traumatic death Data registered according to Utstein style Independent review process

Sport-related sudden death in the general population Marijon, Tafflet, Celermajer, Dumas, Perier, Mustafic, Toussaint, Desnos, Rieu, Bennameur Le Heuzey, Empana, Jouven Circulation 2011;124:672-81

Results (1) Young Competitive Athletes <5% "Young competitive athletes" in 48 cases (6%) Mean age 46±15 yrs Men 95% Free of known cardiopathy in 92% Overall incidence /million/yr

Rational?l

Epidemiology of SCD important challenges Definition Incidence and evolution Heterogeneity of the causes Magic treshold: 35% LVEF Sport related sudden death Sudden death expertise center