Log in to MyACC
HCM Research Explores SCD Risk Stratification, High Intensity Exercise, and Benefits of Valsartan
Although the 2024 ACC/American Heart Association (AHA) and 2023 European Society of Cardiology (ESC) guidelines stratify well overall the risk of sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM), the stratification is insufficient between Classes 2a and 2b, especially when using the ESC guideline criteria, according to a study published March 12 in JACC: Heart Failure.
Masashi Amano, MD, PhD, et al., conducted a retrospective, multicenter analysis of 3,611 patients with HCM in Japan, investigating incidence of SCD events over a five-year period. The authors found that patients with end-stage HCM experienced higher rates of SCD compared to other phenotypes, indicating its predictive value in determining SCD risk.
SCD event rates for each recommendation class were 23.8%, 7.2%, 5.7% and 2.3% for Classes 1, 2a, 2b and 3 of the ACC/AHA guidelines, respectively. For the ESC guidelines, the event rates were 23.8%, 2.9%, 9.3% and 2.6%, respectively. Risk between Classes 2a and 2b was not well stratified by the ACC/AHA guidelines (p=0.101) and with the ESC guidelines, the event rate was reversed (p=0.545).
The authors posit the ESC guidelines' worse discriminatory performance may be "because many patients with [end-stage] HCM ([ejection fraction] <50%) who had a poor prognosis were classified into Class 2b according to the ESC guidelines, and the absolute number of patients classified into Class 2a was small." They suggest "it might thus be necessary to reconsider factors that should be included in SCD risk calculation, especially for applying to non-Westerners."
In a study published on March 3 by the European Heart Journal, a supervised, high intensity exercise program was found to be feasible in patients with HCM and provide potential benefits for patients' cardiovascular and psychological health.
Joyee Basu, MD, et al., sought to determine the safety and efficacy of a high intensity exercise program in patients with HCM. A total of 80 patients were included with 67 completing the study. Half were randomized to a 12-week supervised exercise program and usual care while the control group received usual care alone. The authors considered recruitment, adherence and retention rates; staffing ratios; logistics; and acceptability of intervention to evaluate feasibility of the program.
When comparing experimental vs. control groups, there was no difference in the primary safety outcome – a composite of arrhythmia-related events (p=0.99).
Secondary outcome assessment revealed several improvements in the exercise treatment group, including greater increase in oxygen consumption (VO2) (+4.1 mL/kg/min) and VO2 at anaerobic threshold (+2.3 mL/kg/min), as well as lower systolic blood pressure (–7.3 mm Hg) and BMI (–0.8 kg/m2). The investigators also note improved Hospital Anxiety and Depression Scale scores among patients who participated in the exercise program.
The authors emphasize the need for large-scale studies to corroborate findings from this study and evaluate more long-term effects of high intensity exercise for patients with HCM, a perspective shared by an accompanying editorial comment written by Iacopo Olivotto, MD, and Flavio D'Ascenzi. "Notably, the study was not powered to assess a difference in arrhythmic events between arms; this is a constant hurdle, given the low event rates in HCM populations," they write.
A substudy of the VANISH randomized clinical trial, published March 5 in JAMA Cardiology, identified potential benefit of valsartan for cardiac remodeling and indexed intracellular volume in patients with early stage sarcomeric HCM.
To evaluate treatment effects of valsartan vs. placebo, 137 VANISH participants (mean age 23 years, 37.2% women) underwent CMR imaging at baseline and two years.
John Ostrominski, MD, et al., found that the valsartan treatment group was associated with increased left ventricular (LV) end-diastolic volume index (mean difference [MD], 3.3 mL/m2; p=0.03) and reduction in indexed intracellular volume progression (MD, –2.9 g/m2; p=0.03). There was no significant impact on LV mass index, LVEF, indexed extracellular volume or late gadolinium enhancement progression.
The authors note their findings "support and extend observations from the primary VANISH trial, providing insights into the natural history and mechanisms underlying the putative benefit of valsartan in early-stage sarcomeric HCM."
Additional Citations:
Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Exercise
Keywords: Cardiomyopathy, Hypertrophic, Hypertrophic Cardiomyopathy, Death, Sudden, Cardiac, Exercise Therapy, Arrhythmias, Cardiac, Valsartan
< Back to Listings
