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Sudden death Scope of the problem and risk stratification

Sudden death Scope of the problem and risk stratification . Pr Xavier JOUVEN. INSERM U970 Cardiovascular epidemiology and sudden death. DECLARATION OF CONFLICT OF INTEREST. Nothing to declare. Epidemiology of SCD important challenges. Definition Incidence and evolution

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Sudden death Scope of the problem and risk stratification

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

  2. DECLARATION OF CONFLICT OF INTEREST Nothing to declare

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

  4. Sudden Cardiac Death Prediction and PreventionReport From a National Heart, Lung, and Blood Institute and Heart Rhythm Society Workshop

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

  6. 385 000 major coronaryevents 111 000 out of hospitaldeaths (29%) 36 000 in hospitaldeaths (9.5%)

  7. Mortality due to CHD in the hospital (within 28 days)and out of the hospital per 100 000 population 35 to 84 years of age, 1991 to 2006

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

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

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

  11. Risk of sudden death Myerburg et al. AJC 1987

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

  13. MADIT (1) CABG-Patch (2) CAT (1) MUSTT (3) AMIOVIRT (1) MADIT II (1) SCD-HeFT (4) DINAMIT (5) DEFINITE (5) Clinical trials : primary prevention 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

  14. Goldenberg JACC 2008

  15. Oregon sudden death study 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

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

  17. Incidence of sudden cardiac death in national collegiate athletic association athletes Harmon KG, Asif IM, Klossner D, Drezner JA True incidence of SCD in US athletes Jan 2004-2008: 2 millions athletes participant-year 273 deaths: 187(68%) traumatic causes 45 SCD Circulation 2011, 5 April

  18. “Young Competitive Athletes” Maron AJC 2009 Corrado JAMA 2006 Maron Circulation 2009 France : 10-15 cases/year USA : 1058 cas sur 27 ans Italie : 55 cas sur 25 ans

  19. 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

  20. Methods (1)Setting Under the auspices of the Ministère de la Jeunesse, des Sports et Subjects aged 10-75 years Ongoing prospective French registry from April 2005 carried out by INSERM U970 60/96 districts (33 millions 10-75 yrs inhabits) Exclusion criteria of traumatic death Data registered according to Utstein style Independent review process

  21. 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

  22. Results (1)Young Competitive Athletes <5% • Mean age 46±15 yrs • Men 95% • Free of known cardiopathy in 92% • Overall incidence 17-18/million/yr "Young competitive athletes" in 48 cases (6%)

  23. Rational?l

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

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