Qi Weitang, Pu Lutong, Zhang Jinquan, Chen Hongyu, Tang Zihuan, Wang Jie, Han Yuchi, Chen Yucheng
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
West China School of Public Health, Sichuan University, Chengdu, Sichuan, China.
Curr Probl Cardiol. 2023 Nov;48(11):101875. doi: 10.1016/j.cpcardiol.2023.101875. Epub 2023 Jun 17.
Accurate identification of hypertrophic cardiomyopathy (HCM) patients at high risk of sudden cardiac death (SCD) event is challenging. The objective of this study was to validate the three SCD risk stratifications recommended by the 2014 European Society of Cardiology (ESC) guideline, the 2020 American Heart Association /American College of Cardiology (AHA/ACC) guideline, and the 2022 ESC guideline in Chinese patients with HCM. Our study population are made up of a cohort of 856 HCM patients without prior SCD events. The endpoint was defined as SCD or equivalent events (successful resuscitation after cardiac arrest or appropriate ICD shock for ventricular tachycardia or ventricular fibrillation). During a median follow-up of 43 months, SCD endpoints occurred in 44 (5.1%) patients. A total of 34 (77.3%) patients suffering from SCD events were classified correctly into high-risk groups by the 2020 AHA/ACC guideline, 27(61.4%) by the 2022 ESC guideline, and 13 (29.6%) by the 2014 ESC guideline. The C-statistic of the 2020 AHA/ACC guideline was 0.68 (95% CI, 0.60-0.76), which performed better than the 2022 ESC guideline (0.65: 95% CI, 0.56-0.73), and the 2014 ESC guideline (0.58: 95% CI, 0.48-0.67). The 2020 AHA/ACC guideline displayed better discrimination for SCD risk stratification in Chinese HCM patients than the other two guidelines, with a higher sensitivity but lower specificity.
准确识别肥厚型心肌病（HCM）患者发生心源性猝死（SCD）事件的高风险具有挑战性。本研究的目的是验证2014年欧洲心脏病学会（ESC）指南、2020年美国心脏协会/美国心脏病学会（AHA/ACC）指南以及2022年ESC中国指南推荐的三种SCD风险分层在HCM中国患者中的有效性。我们的研究人群由856例无既往SCD事件的HCM患者组成。终点定义为SCD或等效事件（心脏骤停后成功复苏或因室性心动过速或心室颤动进行适当的植入式心律转复除颤器电击）。在中位随访43个月期间，44例（5.1%）患者发生了SCD终点事件。共有34例（77.3%）发生SCD事件的患者被2020年AHA/ACC指南正确分类为高风险组，27例（61.4%）被2022年ESC指南分类为高风险组，13例（29.6%）被2014年ESC指南分类为高风险组。2020年AHA/ACC指南的C统计量为0.68（95%CI，0.60 - 0.76），其表现优于2022年ESC指南（0.65：95%CI，0.56 - 0.73）和2014年ESC指南（0.58：95%CI，0.48 - 0.67）。2020年AHA/ACC指南在HCM中国患者的SCD风险分层中显示出比其他两个指南更好的辨别能力，具有更高的敏感性但更低的特异性。
