Dong Yan, Yang Wen, Chen Chongchong, Ji Jiamei, Zheng Wei, Zhang Fengxiang, Yang Bing, Li Xiaorong, Zhou Xiujuan
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
Front Cardiovasc Med. 2021 Aug 17;8:691653. doi: 10.3389/fcvm.2021.691653. eCollection 2021.
Sudden cardiac death (SCD) is a common cause of death in hypertrophic cardiomyopathy (HCM), but identification of patients at a high risk of SCD is challenging. The study aimed to validate the three SCD risk stratifications recommended by the 2011 ACCF/AHA guideline, the 2014 ESC guideline, and the 2020 AHA/ACC guideline in Chinese HCM patients. The study population consisted of a consecutive cohort of 511 patients with HCM without a history of SCD event. The endpoint was a composite of SCD or an equivalent event (appropriate implantable cardioverter defibrillator therapy or successful resuscitation after cardiac arrest). During a follow-up of 4.7 ± 1.7 years, 15 patients (2.9%) reached the SCD endpoint and 12 (2.3%) were protected by implantable cardioverter defibrillator for primary prevention. A total of 13 (2.8%) patients experiencing SCD events were misclassified as low-risk patients by the 2011 ACCF/AHA guideline, 12 (2.3%) by the 2014 ESC model, and 7 (1.6%) by the 2020 AHA/ACC guideline. The SCD risk stratification in the 2020 AHA/ACC guideline showed greater area under the curve (0.71; 95% CI 0.56-0.87, < 0.001) than the one in the 2011 ACCF/AHA guideline (0.52; 95% CI 0.37-0.67, = 0.76) and 2014 ESC guideline (0.68; 95% CI 0.54-0.81, = 0.02). The SCD risk stratification recommended by the 2020 AHA/ACC guideline showed a better discrimination than previous stratifications in Chinese patients with HCM. A larger multicenter, independent, and prospective study with long-term follow-up would be warranted to validate our result.
心源性猝死（SCD）是肥厚型心肌病（HCM）常见的死亡原因，但识别SCD高危患者具有挑战性。本研究旨在验证2011年美国心脏病学会基金会/美国心脏协会（ACCF/AHA）指南、2014年欧洲心脏病学会（ESC）指南和2020年美国心脏协会/美国心脏病学会（AHA/ACC）指南推荐的三种SCD风险分层在中国HCM患者中的有效性。研究人群包括511例无SCD事件病史的连续性HCM患者队列。终点为SCD或等效事件（适当的植入式心律转复除颤器治疗或心脏骤停后成功复苏）的复合终点。在4.7±1.7年的随访期间，15例患者（2.9%）达到SCD终点，12例患者（2.3%）接受植入式心律转复除颤器一级预防。共有13例（2.8%）发生SCD事件的患者被2011年ACCF/AHA指南误分类为低风险患者，12例（2.3%）被2014年ESC模型误分类，7例（1.6%）被2020年AHA/ACC指南误分类。2020年AHA/ACC指南中的SCD风险分层曲线下面积（0.71；95%可信区间0.56 - 0.87，P<0.001）大于2011年ACCF/AHA指南（0.52；95%可信区间0.37 - 0.67，P = 0.76）和2014年ESC指南（0.68；95%可信区间0.54 - 0.81，P = 0.02）。2020年AHA/ACC指南推荐的SCD风险分层在中国HCM患者中的鉴别能力优于先前的分层。需要进行一项更大规模的多中心、独立、前瞻性且长期随访的研究来验证我们的结果。
