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Article Dans Une Revue Journal of the American College of Cardiology Année : 2022

Cardiac Outcomes in Adults With Mitochondrial Diseases

Konstantinos Savvatis
Christoffer Rasmus Vissing
Robert D.S. Pitceathly
Luis Rocha Lopes
Thomas D. Gossios
Ros C.M. Quinlivan
  • Fonction : Auteur
Michael G. Hanna
  • Fonction : Auteur
P. M. Elliott

Résumé

Background: Patients with mitochondrial diseases are at risk of heart failure (HF) and arrhythmic major adverse cardiac events (MACE). Objectives: We developed prediction models to estimate the risk of HF and arrhythmic MACE in this population. Methods: We determined the incidence and searched for predictors of HF and arrhythmic MACE using Cox regression in 600 adult patients from a multicenter registry with genetically confirmed mitochondrial diseases. Results: Over a median follow-up time of 6.67 years, 29 patients (4.9%) reached the HF endpoint, including 19 hospitalizations for nonterminal HF, 2 cardiac transplantations, and 8 deaths from HF. Thirty others (5.1%) reached the arrhythmic MACE, including 21 with third-degree or type II second-degree atrioventricular blocks, 4 with sinus node dysfunction, and 5 sudden cardiac deaths. Predictors of HF were the m.3243A>G variant (HR: 4.3; 95% CI: 1.8-10.1), conduction defects (HR: 3.0; 95% CI: 1.3-6.9), left ventricular (LV) hypertrophy (HR: 2.6; 95% CI: 1.1-5.8), LV ejection fraction <50% (HR: 10.2; 95% CI: 4.6-22.3), and premature ventricular beats (HR: 4.1; 95% CI: 1.7-9.9). Independent predictors for arrhythmia were single, large-scale mtDNA deletions (HR: 4.3; 95% CI: 1.7-10.4), conduction defects (HR: 6.8; 95% CI: 3.0-15.4), and LV ejection fraction <50% (HR: 2.7; 95% CI: 1.1-7.1). C-indexes of the Cox regression models were 0.91 (95% CI: 0.88-0.95) and 0.80 (95% CI: 0.70-0.90) for the HF and arrhythmic MACE, respectively. Conclusions: We developed the first prediction models for HF and arrhythmic MACE in patients with mitochondrial diseases using genetic variant type and simple cardiac assessments.

Dates et versions

hal-03837169 , version 1 (02-11-2022)

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Citer

Konstantinos Savvatis, Christoffer Rasmus Vissing, Lori Klouvi, Anca Rezeda Florian, Mehjabin Rahman, et al.. Cardiac Outcomes in Adults With Mitochondrial Diseases. Journal of the American College of Cardiology, 2022, 80 (15), pp.1421-1430. ⟨10.1016/j.jacc.2022.08.716⟩. ⟨hal-03837169⟩
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