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Sudden cardiac death in hyperthrophic cardiomyopathy: Comparison of predictive models
Mohamed Fehmi Bayar1, Emna Bennour2, Zied Ibn El Hadj3
1Specialist in cardiology.
Insights
The new American College of Cardiology (ACC) sudden cardiac death (SCD) risk model for hypertrophic cardiomyopathy (HCM) better identifies high-risk patients but increases implantable cardioverter defibrillator (ICD) recommendations compared to the European Society of Cardiology (ESC) score.
Area of Science:
- Cardiology
- Genetics
- Preventive Medicine
Background:
- Sudden cardiac death (SCD) risk stratification in sarcomeric hypertrophic cardiomyopathy (HCM) is crucial for primary prevention.
- The American College of Cardiology (ACC) recently introduced a new risk stratification model, differing from the previous European Society of Cardiology (ESC) HCM Risk Score.
Purpose of the Study:
- To compare the risk stratification performance of the ACC and ESC risk scores in HCM patients.
- Evaluate the concordance and predictive accuracy of both models in identifying patients at risk for arrhythmic events.
Main Methods:
- Observational, retrospective cohort study design.
- Patients were classified using both ACC and ESC risk models.
- Follow-up period of at least one year to assess arrhythmic events.
Main Results:
- Weak concordance (Kappa = 0.28) observed between the ACC and ESC models.
- The ACC algorithm demonstrated superior predictive potency (AUC = 0.785 vs. 0.654) and higher NRI (0.35).
- The ACC model identified more high-risk patients, leading to a 1.6-fold increase in recommended implantable cardioverter defibrillator (ICD) implantations.
Conclusions:
- The ACC algorithm is more effective in identifying high-risk HCM patients for SCD prevention.
- However, the ACC model significantly increases the number of indicated ICDs, necessitating careful clinical consideration.
Introduction:
Sudden cardiac death (SCD) risk stratification for primary prevention in patients with sarcomeric hypertrophic cardiomyopathy (HCM) has recently been reinforced by the establishment of a new model by the American College of Cardiology (ACC). This algorithm was characterized by a different approach compared to the previous HCM Risk Score.
Aim:
The objective of this study was to compare risk stratification using both the European society of cardiology (ESC) and the ACC risk scores.
Methods:
This was an observational, cohort-type prognostic study with retrospective data collection. Patients were classified according to their rhythmic risk estimated by both models and followed for a period of at least one year.
Results:
Forty-seven patients were followed over a mean period of 32,4 months. The mean age of our patients was 55 years ± 14 years. We found a weak concordance between the two models (Kappa = 0.28). Four patients (9 %) presented arrhythmogenic events. The ACC algorithm indicated the implantation of an implantable cardioverter defibrillator (ICD) for these four patients whereas the HCM Risk Score indicated only two. The American algorithm had a better predictive potency with an area under the ROC curve of 0.785 compared to 0.654 with the HCM Risk Score with an NRI of 0.35. However, the number of ICDs to be implanted according to this algorithm was increased by 1.6 times.
Conclusion:
The ACC algorithm was more efficient in detecting high-risk patients, but it considerably increased the number of ICDs indicated.
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