MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China.
Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China.
Eur Heart J. 2023 Dec 1;44(45):4781-4792. doi: 10.1093/eurheartj/ehad581.
Identifying patients with hypertrophic cardiomyopathy (HCM) who are candidates for implantable cardioverter defibrillator (ICD) implantation in primary prevention for sudden cardiac death (SCD) is crucial. The aim of this study was to externally validate the 2022 European Society of Cardiology (ESC) model and other guideline-based ICD class of recommendation (ICD-COR) models and explore the utility of late gadolinium enhancement (LGE) in further risk stratification.
Seven hundred and seventy-four consecutive patients who underwent cardiac magnetic resonance imaging were retrospectively enrolled.
Forty-six (5.9%) patients reached the SCD-related endpoint during 7.4 ± 2.5 years of follow-up. Patients suffering from SCD had higher ESC Risk-SCD score (4.3 ± 2.4% vs. 2.8 ± 2.1%, P < .001) and LGE extent (13.7 ± 9.4% vs. 4.9 ± 6.6%, P < .001). Compared with the 2014 ESC model, the 2022 ESC model showed increased area under the curve (.76 vs. .63), sensitivity (76.1% vs. 43.5%), positive predictive value (16.8% vs. 13.6%), and negative predictive value (98.1% vs. 95.9%). The C-statistics for SCD prediction of 2011 American College of Cardiology (ACC)/American Heart Association (AHA), 2014 ESC, 2020 AHA/ACC, and 2022 ESC models were .68, .64, .76 and .78, respectively. Furthermore, in patients without extensive LGE, LGE ≥5% was responsible for seven-fold SCD risk after multivariable adjustment. Whether in ICD-COR II or ICD-COR III, patients with LGE ≥5% and <15% showed significantly worse prognosis than those with LGE <5% (all P < .001).
The 2022 ESC model performed better than the 2014 ESC model with especially improved sensitivity. LGE enabled further risk stratification based on current guidelines.
识别肥厚型心肌病（HCM）患者是否适合植入式心脏复律除颤器（ICD）进行一级预防心源性猝死（SCD）至关重要。本研究旨在外部验证 2022 年欧洲心脏病学会（ESC）模型和其他基于指南的 ICD 分类推荐（ICD-COR）模型，并探讨晚期钆增强（LGE）在进一步风险分层中的作用。
回顾性纳入 774 例连续接受心脏磁共振成像检查的患者。
7.4±2.5 年随访期间，46 例（5.9%）患者达到 SCD 相关终点。发生 SCD 的患者 ESC 风险-SCD 评分较高（4.3±2.4%比 2.8±2.1%，P<.001）和 LGE 范围较广（13.7±9.4%比 4.9±6.6%，P<.001）。与 2014 年 ESC 模型相比，2022 年 ESC 模型的曲线下面积（AUC）增加（.76 比.63）、敏感性（76.1%比 43.5%）、阳性预测值（16.8%比 13.6%）和阴性预测值（98.1%比 95.9%）。2011 年美国心脏病学会（ACC）/美国心脏协会（AHA）、2014 年 ESC、2020 年 AHA/ACC 和 2022 年 ESC 模型预测 SCD 的 C 统计量分别为.68、.64、.76 和.78。此外，在没有广泛 LGE 的患者中，多变量调整后 LGE≥5%与 SCD 风险增加 7 倍相关。无论在 ICD-COR II 还是 ICD-COR III 中，LGE≥5%且<15%的患者预后明显差于 LGE<5%的患者（均 P<.001）。
与 2014 年 ESC 模型相比，2022 年 ESC 模型的性能更好，尤其是敏感性提高。LGE 使基于现行指南的进一步风险分层成为可能。
