A pilot study for risk stratification of ventricular tachyarrhythmia in hypertrophic cardiomyopathy with routine
Anselm A Derda1,2, Malin Abelmann2, Jan-Thorben Sieweke1
1Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Insights
Ventricular tachyarrhythmias (VTA) are common in hypertrophic cardiomyopathy (HCM). A new risk model using readily available parameters effectively identifies patients at high risk for VTA, improving sudden cardiac death risk stratification.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiovascular Imaging
Background:
- Ventricular tachyarrhythmias (VTA) are a significant risk factor for sudden cardiac death in hypertrophic cardiomyopathy (HCM) patients.
- Standard Holter ECG monitoring at initial presentation may be insufficient for risk stratification.
- Myocardial remodeling parameters may offer better VTA risk stratification in HCM.
Purpose of the Study:
- To evaluate the efficacy of routinely obtained myocardial remodeling parameters in stratifying VTA risk in HCM patients.
- To develop and validate a risk model for predicting VTA in HCM.
Main Methods:
- A monocentric analysis of 140 HCM patients.
- Inclusion of 12-channel electrocardiography and echocardiography with tissue Doppler imaging.
- Primary endpoint: documentation of non-sustained and sustained VTA via Holter ECG or active devices.
Main Results:
- 27.1% of HCM patients experienced VTA.
- VTA was associated with a history of atrial fibrillation, thicker interventricular septum, and lower peak systolic mitral annular velocity.
- A risk model incorporating these parameters demonstrated good discriminative ability (AUC 0.80).
Conclusions:
- Widely available echocardiographic and clinical parameters can effectively stratify VTA risk in HCM patients.
- The developed risk model aids in distinguishing between low and high-risk individuals for VTA.
- This approach may improve sudden cardiac death risk assessment in HCM.
Abstract:
Ventricular tachyarrhythmia (VTA) are frequent arrhythmias in patients with hypertrophic cardiomyopathy (HCM). Representing a major risk factor for sudden cardiac death, Holter ECG at first clinical presentation appears insufficient. This study aims to investigate the ability of routinely obtained parameters associated with myocardial remodeling in stratifying for VTA in HCM. In this monocentric analysis, patients with HCM underwent 12-channel electrocardiography and echocardiography, including tissue doppler imaging. The study's primary endpoint was the documentation of non-sustained and sustained ventricular tachycardia-summarized as ventricular tachyarrhythmias (VTA) on Holter ECG or active devices. The occurrence of VTA was exploratory. Based on our collective, we developed a risk model regarding VTA. Of 140 HCM patients, 38 (27.1%) had an episode of VTA. Patients with VTA were likelier to have a history of atrial fibrillation (p < 0.001), a thicker interventricular septum (p < 0.001) and lower peak systolic mitral annular velocity (p < 0.001). The parameters were independently associated with endpoint in univariate and multivariate logistic regression. We created a logistic equation and calculated a cut-off value. The resulting ROC curve revealed a discriminative ability with AUC of 0.80 (sensitivity, 63%; specificity, 88%). Our risk model including these widely available parameters is able to distinguish low and high-risk of VTA in patients with HCM.
