Clinic of Cardiomyopathies and Inherited Cardiac Diseases, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece.
Clinic of Cardiomyopathies and Inherited Cardiac Diseases, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece.
Hellenic J Cardiol. 2022 Jan-Feb;63:15-21. doi: 10.1016/j.hjc.2021.06.005. Epub 2021 Jun 17.
The aim of our study was to assess the performance of the new American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines, with respect to sudden cardiac death (SCD) prevention, in comparison with the established risk score of the European Society of Cardiology (hypertrophic cardiomyopathy [HCM] Risk-SCD), in a large Mediterranean cohort of HCM patients.
The clinical and imaging characteristics of 784 HCM patients (mean age at first evaluation 52 ± 16 years, 67.2% males) were analyzed retrospectively. The sensitivity, specificity, and negative predictive value for SCD events of the presence of ≥1 risk factor for SCD according to the ACC/AHA Guidelines 2020 and of the HCM Risk-SCD≥6% and HCM Risk-SCD≥4% were estimated during follow-up.
During follow-up, 47 (6%) patients suffered an SCD event. The presence of ≥1 major risk factor for SCD according to the new ACC/AHA Guidelines had 96% sensitivity (95% CI 85.5-99.5%) with modest specificity of 59% (95% CI 55-62.2%) and negative predictive value of 99.5% (95% CI 98.2-99.9%). On the contrary, HCM- Risk-SCD≥6% had a relatively low sensitivity (32%, 95% CI 19.1-47.1%) and high specificity of 95% (95% CI 93.1-96.4%), whereas, HCM-Risk-SCD≥4% had sensitivity of 60% (95% CI 44-74%) and specificity of 83.9% (95% CI 80-85.6%). Both the HCM Risk-SCD cut-off values demonstrated lower negative predictive value but higher accuracy than the ACC/AHA algorithm for SCD prediction.
The novel ACC/AHA proposed algorithm identifies most of the patients with an SCD event with the cost of numerous defibrillator implantations. HCM-Risk-SCD demonstrated higher specificity, whereas its sensitivity and negative predictive value are modest.
本研究旨在评估新的美国心脏病学会（ACC）/美国心脏协会（AHA）指南在预防心源性猝死（SCD）方面的表现，与欧洲心脏病学会（ESC）确立的风险评分（肥厚型心肌病[HCM]风险-SCD）相比，在一个大型地中海 HCM 患者队列中。
回顾性分析 784 例 HCM 患者（首次评估时的平均年龄为 52±16 岁，男性占 67.2%）的临床和影像学特征。根据 2020 年 ACC/AHA 指南，估计存在≥1 个 SCD 危险因素和 HCM 风险-SCD≥6%和 HCM 风险-SCD≥4%时，SCD 事件的敏感性、特异性和阴性预测值。
在随访期间，47 例（6%）患者发生 SCD 事件。根据新的 ACC/AHA 指南，存在≥1 个主要 SCD 危险因素的患者具有 96%的敏感性（95%置信区间 85.5-99.5%），特异性适中为 59%（95%置信区间 55-62.2%），阴性预测值为 99.5%（95%置信区间 98.2-99.9%）。相反，HCM-Risk-SCD≥6%的敏感性相对较低（32%，95%置信区间 19.1-47.1%），特异性为 95%（95%置信区间 93.1-96.4%），而 HCM-Risk-SCD≥4%的敏感性为 60%（95%置信区间 44-74%），特异性为 83.9%（95%置信区间 80-85.6%）。两种 HCM 风险-SCD 截断值在 SCD 预测方面，其阴性预测值较低，但准确性均高于 ACC/AHA 算法。
新的 ACC/AHA 提出的算法确定了大多数发生 SCD 事件的患者，但需要进行多次除颤器植入。HCM-Risk-SCD 具有更高的特异性，但其敏感性和阴性预测值适中。
