Related Experiment Videos
A pragmatic clinical risk score for adverse outcomes in hypertrophic cardiomyopathy using routine laboratory and
1Department of Intensive Care Medicine, Jiujiang No.1 People's Hospital, Jiujiang, Jiangxi Province, China. chenziyi1123@163.com.
Insights
A new risk score aids short-term prediction of adverse outcomes in hypertrophic cardiomyopathy (HCM). This pragmatic tool uses routine data to help stratify patients and guide follow-up care.
Area of Science:
- Cardiology
- Clinical Risk Prediction
- Biomarkers
Background:
- Hypertrophic cardiomyopathy (HCM) presents challenges for early risk prediction, especially for short-term adverse events.
- Current risk stratification methods may not fully capture the complexity of short-term outcomes in HCM patients.
Purpose of the Study:
- To develop and validate a pragmatic risk score for predicting 1-year composite adverse outcomes in adults with HCM.
- To utilize routinely available clinical, laboratory, arrhythmic, and echocardiographic variables for risk assessment.
Main Methods:
- A retrospective cohort study of 1,200 Chinese adults with HCM.
- Development of a point-based risk score using logistic regression and internal validation via bootstrap resampling and cross-validation.
- Primary endpoint: 1-year composite of sudden cardiac death (SCD) or equivalent, heart failure hospitalization, or all-cause mortality.
Main Results:
- The HCM Pragmatic Risk Score includes ten predictors: age ≥ 60, nonsustained ventricular tachycardia, syncope, maximal LV wall thickness ≥ 20 mm, LA diameter ≥ 45 mm, LV outflow tract gradient ≥ 30 mmHg, LVEF < 50%, NT-proBNP > 1,000 pg/mL, elevated troponin, and creatinine > 1.2 mg/dL.
- The score demonstrated moderate discrimination (AUC=0.75, optimism-corrected AUC=0.74) and good calibration, with increasing event rates across risk strata (3.8%, 16.7%, 77.8%).
- Heart failure hospitalization was the main driver of the composite endpoint.
Conclusions:
- The developed HCM Pragmatic Risk Score can aid in short-term risk stratification and follow-up planning for HCM patients.
- The score is not intended as a dedicated sudden cardiac death prediction model or an implantable cardioverter-defibrillator decision tool.
- External validation of the HCM Pragmatic Risk Score is necessary.
Background:
Early risk prediction in hypertrophic cardiomyopathy (HCM) remains challenging, particularly for short-term adverse outcomes. We aimed to develop a pragmatic risk score for predicting 1-year composite adverse outcomes using routinely available clinical, laboratory, arrhythmic, and echocardiographic variables.
Methods:
This single-center retrospective cohort study included 1,200 Chinese adults with HCM evaluated between 2015 and 2024. The primary endpoint was a 1-year composite of sudden cardiac death (SCD) or SCD-equivalent events, heart failure hospitalization, or all-cause mortality. Candidate predictors were selected based on clinical relevance, routine availability, and prior HCM risk evidence, followed by univariate screening and multivariable logistic regression with stepwise selection. A point-based score was developed and internally validated using 1,000 bootstrap resamples and stratified 5-fold cross-validation.
Results:
During follow-up, 120 patients experienced the composite endpoint, including heart failure hospitalization in 78 patients, SCD or SCD-equivalent events in 24, and all-cause mortality in 18. Ten predictors were included in the HCM Pragmatic Risk Score: age ≥ 60 years, nonsustained ventricular tachycardia, unexplained syncope, maximal left ventricular wall thickness ≥ 20 mm, left atrial diameter ≥ 45 mm, left ventricular outflow tract gradient ≥ 30 mmHg, left ventricular ejection fraction < 50%, NT-proBNP > 1,000 pg/mL, elevated troponin, and creatinine > 1.2 mg/dL. The score showed moderate discrimination (AUC = 0.75) and good calibration. Event rates increased across risk strata: 3.8%, 16.7%, and 77.8%. Bootstrap validation yielded an optimism-corrected AUC of 0.74.
Conclusion:
The HCM Pragmatic Risk Score may assist short-term risk stratification and follow-up planning. Because the endpoint was mainly driven by heart failure hospitalization, it should not be interpreted as a dedicated SCD prediction model or stand-alone ICD decision tool. External validation is required.
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