Department of Cardiology, St. Antonius Hospital Nieuwegein, Koekoekslaan 1, EM Nieuwegein, The Netherlands.
Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstrasse 11, Bad Oeynhausen, Germany.
Europace. 2018 Sep 1;20(FI2):f198-f203. doi: 10.1093/europace/eux251.
The HCM Risk-SCD model for prediction of sudden cardiac death (SCD) in hypertrophic cardiomyopathy recommended by the 2014 European Society of Cardiology (ESC) guidelines has not been validated after septal reduction therapy. The aim of this study was to validate the HCM Risk-SCD model in patients undergoing alcohol septal ablation (ASA) and to compare its performance to previous models.
A total of 844 ASA patients without prior SCD event were included. The primary endpoint was a composite of SCD and appropriate implantable cardioverter defibrillator (ICD) therapy, identical to the HCM Risk-SCD endpoint. A distinction between periprocedural (≤30 days) and long-term (>30 days) SCD was made to discern procedure-related adverse arrhythmic events caused by the ASA-induced myocardial infarction from long-term SCD risk. Twenty patients reached the SCD endpoint within the first 30 days. During a follow-up of 6.5 ± 4.2 years, another 46 patients reached the SCD endpoint. The predicted 5-year SCD risk according to the HCM Risk-SCD model was 5.1%, and the observed 5-year SCD risk was 4.0%. The C-statistics for the use of the HCM Risk-SCD model was 0.61 (P = 0.02), the C-statistics for the use of the 2003 American College of Cardiology/ESC guidelines was 0.59 (P = 0.051), and the C-statistic for the use of the 2011 American College of Cardiology Foundation/American Heart Association guidelines was 0.58 (P = 0.054). Maximal left ventricular wall thickness, syncope after ASA, and fulfilling the 2014 ESC recommendations for primary ICD implantation according to the HCM Risk-SCD model, respectively, predicted SCD during long-term follow-up.
The HCM Risk-SCD model can be used for SCD prediction in patients undergoing ASA.
2014 年欧洲心脏病学会（ESC）指南推荐的肥厚型心肌病（HCM）风险-SCD 模型用于预测心脏性猝死（SCD），但该模型在室间隔减容治疗后尚未得到验证。本研究旨在验证该模型在接受酒精室间隔消融术（ASA）的患者中的有效性，并比较其与既往模型的表现。
共纳入 844 例无既往 SCD 事件的 ASA 患者。主要终点是 SCD 和适当的植入式心脏复律除颤器（ICD）治疗的复合终点，与 HCM Risk-SCD 终点相同。区分围手术期（≤30 天）和长期（>30 天）SCD，以区分由 ASA 引起的心肌梗死导致的与长期 SCD 风险相关的程序相关不良心律失常事件。20 例患者在 30 天内达到 SCD 终点。在 6.5±4.2 年的随访中，又有 46 例患者达到 SCD 终点。根据 HCM Risk-SCD 模型预测的 5 年 SCD 风险为 5.1%，观察到的 5 年 SCD 风险为 4.0%。HCM Risk-SCD 模型的 C 统计量为 0.61（P=0.02），2003 年美国心脏病学会/ESC 指南的 C 统计量为 0.59（P=0.051），2011 年美国心脏病学会基金会/美国心脏协会指南的 C 统计量为 0.58（P=0.054）。最大左室壁厚度、ASA 后晕厥以及根据 HCM Risk-SCD 模型符合 2014 年 ESC 推荐的 ICD 一级植入标准，分别预测长期随访期间的 SCD。
HCM Risk-SCD 模型可用于预测接受 ASA 的患者的 SCD。
