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

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Nothing to declare DECLARATION OF CONFLICT OF INTEREST

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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

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

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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

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385 000 major coronary events 111 000 out of hospital deaths (29%) 36 000 in hospital deaths (9.5%)

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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

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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

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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

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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

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Risk of sudden death Myerburg et al. AJC 1987

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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

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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

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Goldenberg JACC 2008

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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

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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

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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 2004-2008: 2 millions athletes participant-year 273 deaths:187(68%) traumatic causes 45 SCD

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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 : 10-15 cases/year

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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

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Methods (1) Setting Under the auspices of the Ministre 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

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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

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Results (1) Young Competitive Athletes