Oliveira Antunes Murillo, Fernandes Fabio, Arteaga-Fernandez Edmundo, Alvarez Ramires Félix José, Machado Correia Vinicius, Novaes Cardoso Juliano, Romero Cristhian Espinoza, Sousa Henrique Martins, Soliani Marília Taily, Dal Piaz Matheus Ramos Ramos, Rodrigues Gandarella Anna Danielle, Rocha Teixeira Ruiza Gonçalves, Mady Charles, Assis Moura Tavares Caio, Guimarães Patricia O, Madrini Junior Vagner
Instituto do Coração, Faculdade de Medicina Universidade de São Paulo, São Paulo, Brazil.
Universidade de São Francisco, São Paulo, Brazil.
Glob Heart. 2024 Dec 17;19(1):94. doi: 10.5334/gh.1380. eCollection 2024.
Sudden cardiac death (SCD) is a major concern in patients with hypertrophic cardiomyopathy (HCM). The American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) have different guidelines for SCD risk stratification. Their comparative performance in diverse populations remains uncertain.
Evaluate the performance of the 2020 ACC/AHA and 2014 ESC guidelines for SCD stratification in a Brazilian cohort with HCM.
This retrospective cohort study included patients diagnosed with HCM who were followed in a dedicated clinic at a tertiary hospital in Brazil. The primary outcome was SCD, aborted cardiac arrest due to ventricular fibrillation (VF), sustained ventricular tachycardia (SVT), an episode of VF or SVT, or appropriate ICD therapy. Risk prediction models were assessed using the C-index.
A total of 187 patients were included, with a mean follow-up of 8.3 years. The 2020 ACC/AHA guidelines classified 106 (56%) patients as high-risk for SCD, while the 2014 ESC guidelines identified 54 (29%). The primary outcome occurred in 12% of the high-risk group identified by the ACC/AHA guidelines and 13% of the high-risk group identified by the ESC guidelines. Both guidelines showed low discriminatory power for SCD risk in this Brazilian cohort, with AUC values of 0.634 and 0.581 for the ACC/AHA and ESC guidelines, respectively.
The 2020 ACC/AHA and 2014 ESC guidelines have limitations in predicting SCD events and defining ICD indications in Brazilian HCM patients. Further studies are needed to refine risk stratification and optimize SCD prevention in this population.
心脏性猝死（SCD）是肥厚型心肌病（HCM）患者的主要关注点。美国心脏病学会/美国心脏协会（ACC/AHA）和欧洲心脏病学会（ESC）对SCD风险分层有不同的指南。它们在不同人群中的比较表现仍不确定。
评估2020年ACC/AHA和2014年ESC指南在巴西HCM队列中对SCD分层的表现。
这项回顾性队列研究纳入了在巴西一家三级医院的专科诊所接受随访的确诊为HCM的患者。主要结局是SCD、因室颤（VF）导致的心脏骤停未遂、持续性室性心动过速（SVT）、一次VF或SVT发作，或适当的植入式心律转复除颤器（ICD）治疗。使用C指数评估风险预测模型。
共纳入187例患者，平均随访8.3年。2020年ACC/AHA指南将106例（56%）患者归类为SCD高危，而2014年ESC指南识别出54例（29%）。ACC/AHA指南确定的高危组中12%发生了主要结局，ESC指南确定的高危组中13%发生了主要结局。在这个巴西队列中，这两个指南对SCD风险的鉴别能力都较低，ACC/AHA和ESC指南的曲线下面积（AUC）值分别为0.634和0.581。
2020年ACC/AHA和2014年ESC指南在预测巴西HCM患者的SCD事件和确定ICD适应证方面存在局限性。需要进一步研究以完善该人群的风险分层并优化SCD预防。
