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Risk Prediction Models and Scores in Hypertrophic Cardiomyopathy
Thomas D Gossios1, Konstantinos Savvatis2, Thomas Zegkos3
1Cardiology Department, St Thomas' Hospital, Guy's and St Thomas' NHS Trust, London, United Kingdom.
Insights
Identifying hypertrophic cardiomyopathy patients at high risk for sudden cardiac death (SCD) is crucial. This review compares American and European guidelines and novel markers for accurate SCD risk stratification in hypertrophic cardiomyopathy (HCM).
Area of Science:
- Cardiology
- Genetics
- Medical Imaging
Background:
- Hypertrophic cardiomyopathy (HCM) is a significant risk factor for sudden cardiac death (SCD).
- Accurate risk stratification is essential to guide interventions like defibrillator implantation.
- Current guidelines show discrepancies in risk factor assessment between American and European approaches.
Purpose of the Study:
- To systematically review and compare the risk stratification models for SCD in HCM patients.
- To evaluate the predictive capacity of established and novel risk factors.
- To discuss the potential of emerging markers to improve current risk assessment.
Main Methods:
- Systematic literature review of studies on SCD risk stratification in HCM.
- Comparative analysis of American and European guidelines for HCM risk assessment.
- Evaluation of genetic testing and advanced imaging techniques for SCD risk prediction.
Main Results:
- Established risk factors are used, but discrepancies exist between major guidelines.
- Novel markers from genetic testing and imaging show promise for enhanced risk prediction.
- Current models may not fully capture the heterogeneity of SCD risk in HCM.
Conclusions:
- Improved precision in SCD risk stratification for HCM is needed.
- Integrating novel markers may refine current guidelines and personalize patient management.
- Timely identification of high-risk patients can significantly alter the natural history of HCM.
Abstract:
Hypertrophic cardiomyopathy (HCM) has historically been linked with sudden cardiac death (SCD). Currently, it is well established that only a subset of patients is at the highest risk stratum for such a catastrophic event. Detection of patients belonging to this high-risk category can allow for timely defibrillator implantation, changing the natural history of HCM. Inversely, device implantation in patients deemed at low risk leads to an unnecessary burden of device complications with no apparent protective benefit. Previous studies have identified a series of markers, now considered established risk factors, with genetic testing and newer imaging allowing for the detection of novel, highly promising indices of increased risk for SCD. Despite the identification of a number of risk factors, there is noticeable discrepancy in the utility of such factors for risk stratification between the current American and European guidelines. We sought to systematically review the data available on these two approaches, presenting their rationale and respective predictive capacity, also discussing the potential of novel markers to augment the precision of currently used risk stratification models for SCD in HCM.
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