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SCD Risk Prediction Model in Hypertrophic Cardiomyopathy | Journal Scan
Study Questions:
How good is the new Risk of Sudden Cardiac Death (SCD) model in hypertrophic cardiomyopathy (HCM), and how does it compare with 2003 and 2011 HCM SCD guidelines?
Methods:
The study population consisted of 706 adults with HCM at two medical centers. Patients with history of ventricular tachycardia or cardiac arrest were excluded. The primary endpoint was a composite of SCD and appropriate implantable cardioverter-defibrillator (ICD) therapy. The 5-year SCD risk was calculated using the HCM Risk-SCD formula. Receiver operating characteristic curves and C-statistics were calculated for the 2014 European Society of Cardiology (ESC) guidelines, and risk stratification methods of the 2003 American College of Cardiology (ACC)/ESC guidelines and 2011 American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) guidelines.
Results:
Mean age was 49 ± 16 years. Mean follow-up was 7.7 ± 5.3 years. SCD occurred in 42 (5.9%) patients. The new HCM Risk-SCD model performed better than the conventional risk factor models from the 2003 and 2011 guidelines. The C-statistics of the three models were 0.69 (95% confidence interval [CI], 0.57-0.82; p = 0.008), 0.55 (95% CI, 0.47-0.63; p = 0.3), and 0.60 (95% CI, 0.50-0.70; p = 0.07), respectively.
Conclusions:
The HCM Risk-SCD model improves the risk stratification of HCM patients for primary prevention of SCD.
Perspective:
The 2003 and 2011 guidelines on the assessment of SCD in patients with HCM are based on five established risk factors to determine whether or not patients with HCM are at increased risk of SCD: family history, syncope, nonsustained ventricular tachycardia, maximum left ventricular wall thickness, and abnormal blood pressure response during exercise. The new HCM Risk-SCD model has eliminated abnormal blood pressure response from risk stratification. Other features of the new SCD-risk model are the following: (1) increasing age is a protective factor; (2) left ventricular wall thickness is no longer regarded as dichotomous, but as a continuous variable; and (3) left atrial diameter and left ventricular outflow tract gradient are added as continuous risk factors. The new model is available at http://www.doc2do.com/hcm/webHCM.html. The present study finds that the new HCM SCD risk model offers improved risk stratification, helping physicians and patients make the decision regarding ICD implantation for primary prevention of SCD.
Keywords: Arrhythmias, Cardiac, Blood Pressure, Cardiomyopathy, Hypertrophic, Death, Sudden, Cardiac, Defibrillators, Implantable, Follow-Up Studies, Heart Failure, Primary Prevention, ROC Curve, Risk Factors, Syncope, Tachycardia, Ventricular
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