增强的美国心脏病学会/美国心脏协会策略可改善中国肥厚型心肌病患者的心脏性猝死风险预测。
Improvement in sudden cardiac death risk prediction by the enhanced American College of Cardiology/American Heart Association strategy in Chinese patients with hypertrophic cardiomyopathy.
机构信息
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
出版信息
Heart Rhythm. 2020 Oct;17(10):1658-1663. doi: 10.1016/j.hrthm.2020.04.017. Epub 2020 Apr 18.
BACKGROUND
The lack of validated and effective sudden cardiac death (SCD) risk prediction methods is the biggest barrier to perform the lifesaving treatment with a prophylactic implantable cardioverter-defibrillator in Chinese patients with hypertrophic cardiomyopathy (HCM).
OBJECTIVE
This study aimed to evaluate the efficacy of 3 existing SCD risk prediction methods recommended by the 2011 American College of Cardiology Foundation and American Heart Association (ACCF/AHA) guideline, the 2014 European Society of Cardiology (ESC) guideline, and the 2019 enhanced American College of Cardiology (ACC)/AHA strategy in Chinese patients with HCM.
METHODS
The present study consisted of 1369 consecutive adult patients with HCM without a history of SCD events. The primary end point was a composite of SCD and equivalent events, namely, resuscitation from cardiac arrest and appropriate implantable cardioverter-defibrillator shock therapy for ventricular tachycardia or fibrillation.
RESULTS
During follow-up of 3.2 ± 2.4 years, 39 patients reached SCD end points, of whom 26 (66.7%) were correctly predicted as those at a high risk of SCD by using methods recommended by the 2019 enhanced ACC/AHA strategy, 20 (51.3%) by the 2011 ACCF/AHA guideline, but only 5 (12.8%) by the 2014 ESC guideline. The 2019 enhanced ACC/AHA strategy showed a higher C-statistic (0.647) for SCD prediction than did the 2011 ACCF/AHA guideline (0.598) and 2014 ESC guideline (0.605) and resulted in the correct reclassification of SCD risk when compared with the 2011 ACCF/AHA guideline (net reclassification index 0.113; P = .074) and 2014 ESC guideline (net reclassification index 0.245; P = .038).
CONCLUSION
The 2019 enhanced ACC/AHA strategy showed better predictive performance for SCD risk stratification in Chinese patients with HCM, with a notably high sensitivity.
背景
缺乏经过验证和有效的心脏性猝死（SCD）风险预测方法，是在患有肥厚型心肌病（HCM）的中国患者中使用预防性植入式心脏复律除颤器进行救生治疗的最大障碍。
目的
本研究旨在评估 2011 年美国心脏病学会基金会和美国心脏协会（ACCF/AHA）指南、2014 年欧洲心脏病学会（ESC）指南和 2019 年增强版美国心脏病学会（ACC）/AHA 策略中推荐的 3 种现有的 SCD 风险预测方法在中国 HCM 患者中的疗效。
方法
本研究纳入了 1369 例连续的成年 HCM 患者，无 SCD 事件史。主要终点是 SCD 和等效事件的复合终点，即心脏骤停复苏和因室性心动过速或颤动而进行的适当植入式心脏复律除颤器电击治疗。
结果
在 3.2±2.4 年的随访期间，39 例患者达到 SCD 终点，其中 26 例（66.7%）根据 2019 年增强版 ACC/AHA 策略推荐的方法被正确预测为 SCD 高危患者，20 例（51.3%）根据 2011 年 ACCF/AHA 指南预测，但仅 5 例（12.8%）根据 2014 年 ESC 指南预测。与 2011 年 ACCF/AHA 指南（0.598）和 2014 年 ESC 指南（0.605）相比，2019 年增强版 ACC/AHA 策略在 SCD 预测方面具有更高的 C 统计量（0.647），并且与 2011 年 ACCF/AHA 指南相比，正确地重新分类了 SCD 风险（净重新分类指数 0.113；P=0.074）和 2014 年 ESC 指南（净重新分类指数 0.245；P=0.038）。
结论
2019 年增强版 ACC/AHA 策略在中国 HCM 患者中对 SCD 风险分层具有更好的预测性能，具有很高的敏感性。
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