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Validation of ACC/AHA and ESC Sudden Cardiac Death Risk Guidelines in Diverse Hypertrophic Cardiomyopathy Cohort:

Murillo Oliveira Antunes1,2, Fabio Fernandes1, Edmundo Arteaga-Fernandez1

  • 1Instituto do Coração, Faculdade de Medicina Universidade de São Paulo, São Paulo, Brazil.

Global Heart
|December 23, 2024
PubMed

Insights

Current sudden cardiac death (SCD) risk guidelines from ACC/AHA and ESC show limited predictive power in Brazilian hypertrophic cardiomyopathy (HCM) patients. Further research is needed to improve SCD prevention strategies for this population.

Area of Science:

  • Cardiology
  • Genetics
  • Public Health

Background:

  • Sudden cardiac death (SCD) is a significant risk in hypertrophic cardiomyopathy (HCM) patients.
  • Existing risk stratification guidelines from the American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) differ.
  • The comparative effectiveness of these guidelines in diverse populations is not well-established.

Purpose of the Study:

  • To evaluate the performance of the 2020 ACC/AHA and 2014 ESC guidelines for SCD risk stratification.
  • To assess these guidelines in a Brazilian cohort of patients with HCM.

Main Methods:

  • Retrospective cohort study of 187 Brazilian HCM patients.
  • Primary outcome: SCD, aborted cardiac arrest, ventricular fibrillation (VF), sustained ventricular tachycardia (SVT), or appropriate implantable cardioverter-defibrillator (ICD) therapy.
  • Risk prediction models assessed using the C-index and Area Under the Curve (AUC).

Main Results:

  • The 2020 ACC/AHA guidelines identified 56% as high-risk, versus 29% by the 2014 ESC guidelines.
  • The primary outcome occurred in 12% (ACC/AHA high-risk) and 13% (ESC high-risk) of patients.
  • Both guidelines demonstrated low discriminatory power (AUC 0.634 for ACC/AHA, 0.581 for ESC) in this cohort.

Conclusions:

  • The 2020 ACC/AHA and 2014 ESC guidelines have limitations for predicting SCD events in Brazilian HCM patients.
  • Current guidelines may not be optimal for defining implantable cardioverter-defibrillator (ICD) indications in this population.
  • Further research is required to refine risk stratification and optimize SCD prevention strategies for Brazilian HCM patients.
Abstract

Keywords:
hypertrophic cardiomyopathyimplantable cardioverter-defibrillatorssudden cardiac death

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