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Long QT molecular autopsy in sudden infant death syndrome.

ABSTRACT: To describe experience of long QT (LQT) molecular autopsy in sudden infant death syndrome (SIDS).Descriptive audit from two distinct periods: (1) A prospective, population-based series between 2006 and 2008 ('unselected'). (2) Before and after 2006-2008, with testing guided by a cardiac genetic service ('selected'). LQT genes 1, 2, 3, 5, 6 and 7 were sequenced. Next of kin were offered cardiac evaluation.New Zealand.102 SIDS cases.Nil. Main outcome measures Detection of genetic variants.Maori 49 (47%), and Pacific island 24 (23%), infants were over-represented. Risk factors were common; bed sharing was reported in 49%. Rare genetic variants were commoner within the selected than unselected populations (5 of 31 infants (16%) vs 3 of 71 infants (4%) p?

SUBMITTER: Glengarry JM

PROVIDER: S-EPMC4078670 | biostudies-literature | 2014 Jul

REPOSITORIES: biostudies-literature

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Long QT molecular autopsy in sudden infant death syndrome.

Glengarry Joanna Moira JM Crawford Jackie J Morrow Paul Lowell PL Stables Simon Robert SR Love Donald Roy DR Skinner Jonathan Robert JR

Archives of disease in childhood 20140304 7

<h4>Objective</h4>To describe experience of long QT (LQT) molecular autopsy in sudden infant death syndrome (SIDS).<h4>Design</h4>Descriptive audit from two distinct periods: (1) A prospective, population-based series between 2006 and 2008 ('unselected'). (2) Before and after 2006-2008, with testing guided by a cardiac genetic service ('selected'). LQT genes 1, 2, 3, 5, 6 and 7 were sequenced. Next of kin were offered cardiac evaluation.<h4>Setting</h4>New Zealand.<h4>Patients</h4>102 SIDS cases ...[more]

PMID: 24596401

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Project description:ImportanceQT-prolonging medications (QTPMs) are a reported risk factor for sudden cardiac death (SCD) when defined by consensus criteria that presume an arrhythmic cause. The effect of QTPM on autopsy-defined sudden arrhythmic death (SAD) is unknown.ObjectiveTo evaluate the association between QTPM and autopsy-defined SAD vs nonarrhythmic cause of sudden death.Design, setting, and participantsThis prospective countywide case-control study included World Health Organization-defined (presumed) SCD cases who underwent autopsy as part of the San Francisco Postmortem Systematic Investigation of Sudden Cardiac Death Study (POST SCD) to determine arrhythmic or nonarrhythmic cause, and control deaths due to trauma (hereinafter referred to as trauma controls) in San Francisco County, California, from February 1, 2011, to March 1, 2014. Multivariate regression was used to evaluate the association of QTPM with the risk of presumed SCD, autopsy-defined SAD, and non-SAD compared with trauma controls. Medication exposure, determined by prescription lists and postmortem toxicologic findings, was used to calculate a summative QTPM exposure score (range, 0-20). Data were analyzed from September 1, 2018, to June 15, 2019.ExposureQT-prolonging medication exposure, as measured by QTPM score (1 indicated low; 2-4, moderate; and >4, high).Main outcomes and measuresDeath due to trauma, presumed SCD, and autopsy-defined non-SAD and SAD with no postmortem findings of extracardiac cause.ResultsA total of 629 patients (mean [SD] age, 61.4 [15.7] years; 439 men [69.8%]) were included, 525 with presumed SCDs and 104 traumatic death controls. Individuals with presumed SCDs had higher exposure and were more likely to be taking any QTPM (291 [55.4%] vs 28 [26.9%]; P?<?.001) than trauma controls. Use of QTPMs was associated with increased risk of presumed SCD in low (odds ratio [OR], 2.25 [95% CI, 1.03-4.96]; P?=?.04) and high (OR, 6.70 [95% CI, 1.47-30.67]; P?=?.01) exposure groups. After autopsy adjudication, use of QTPMs was associated with increased risk of non-SAD (low-risk OR, 2.88 [95% CI, 1.18-6.99; P?=?.02]; moderate-risk OR, 2.62 [95% CI, 1.20-5.73; P?=?.02]; and high-risk OR, 14.22 [95% CI, 2.91-69.30; P?=?.001]) but not SAD in all exposure groups. This association was attenuated by the exclusion of occult overdose non-SADs in the highest exposure group.Conclusions and relevanceThese findings confirm the association between QTPMs and presumed SCD; however, after autopsy, this risk was specific for nonarrhythmic causes of sudden death. Studies using consensus SCD criteria may overestimate the association of QTPMs with the risk of SAD.

Dataset Information

Long QT molecular autopsy in sudden infant death syndrome.

Publications

Long QT molecular autopsy in sudden infant death syndrome.

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