Scolari Fernando Luís, Garbin Henrique Iahnke, de Carvalho Guilherme Dagostin, Rodrigues Fernanda Thomaz, de Menezes Rodrigo Araujo, Correia Edileide de Barros, Bittencourt Marcelo Imbroinise
Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Post-Graduation Program in Cardiology and Cardiovascular Sciences, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Am J Cardiol. 2025 Feb 1;236:86-91. doi: 10.1016/j.amjcard.2024.11.007. Epub 2024 Nov 17.
Sudden cardiac death (SCD) risk stratification and primary prevention implantable cardioverter-defibrillator (ICD) recommendations are based on differing strategies for hypertrophic cardiomyopathy (HCM). This study aimed to evaluate the impact of the 2023 European Society of Cardiology (ESC) guidelines on the 2014 ESC and the 2024 American Heart Association (AHA)/American College of Cardiology (ACC) systems in terms of primary prevention ICD recommendations for HCM. A cohort of 200 patients with HCM in Brazil was assessed for SCD risk profile according to current guidelines. The agreement for primary prevention ICD recommendations was evaluated among different strategies. SCD and appropriate shock were defined as the end points. Among the 200 patients, 63 (31%) received a primary prevention ICD, with 10 (15.8%) receiving appropriate shocks. Low agreement was found among the guidelines (Fleiss' kappa 0.340, 95% confidence interval [CI] 0.286 to 0.395, p <0.001). The European systems showed moderate agreement. The 2024 AHA/ACC algorithm placed 58% of patients in class IIa, whereas only 29% achieved this recommendation with the 2023 ESC model. The end points occurred in 8% of patients over 9.4 ± 6.5 years. The 2014 ESC guidelines had the highest accuracy (77%, 95% CI 71 to 83) and negative predictive value (96%, 95% CI 90 to 98) in detecting patients in class IIa with primary end points. However, all guidelines showed a low positive predictive value. The 2024 AHA/ACC guidelines classified the largest proportion of patients (81%) with the primary end point as class IIa. Low agreement was found among guidelines regarding primary prevention ICD recommendations in HCM, particularly between the 2023 ESC and 2024 AHA/ACC systems.
心脏性猝死（SCD）风险分层及原发性预防植入式心律转复除颤器（ICD）的推荐是基于肥厚型心肌病（HCM）的不同策略。本研究旨在评估2023年欧洲心脏病学会（ESC）指南相对于2014年ESC指南以及2024年美国心脏协会（AHA）/美国心脏病学会（ACC）系统，在HCM原发性预防ICD推荐方面的影响。根据现行指南，对巴西的200例HCM患者队列进行了SCD风险评估。评估了不同策略之间原发性预防ICD推荐的一致性。将SCD和恰当电击定义为终点。在这200例患者中，63例（31%）接受了原发性预防ICD，其中10例（15.8%）接受了恰当电击。指南之间的一致性较低（Fleiss'卡方值0.340，95%置信区间[CI] 0.286至0.395，p<0.001）。欧洲的系统显示出中等一致性。2024年AHA/ACC算法将58%的患者归为IIa类，而2023年ESC模型仅有29%的患者符合该推荐。终点事件发生在9.4±6.5年期间8%的患者中。2014年ESC指南在检测具有主要终点的IIa类患者方面具有最高的准确性（77%，95% CI 71至83）和阴性预测值（96%，95% CI 90至98）。然而，所有指南的阳性预测值均较低。2024年AHA/ACC指南将最大比例（81%）具有主要终点的患者归为IIa类。在HCM原发性预防ICD推荐方面，指南之间的一致性较低，尤其是2023年ESC和2024年AHA/ACC系统之间。
