Arrhythmic risk stratification in hypertrophic cardiomyopathy: are we missing something?

Influence of standard modifiable risk factors on ventricular tachycardia after myocardial infarction

“…Confirming an EPS-guided strategy for the primary prevention of sudden cardiac death requires a large, multicenter, randomized, controlled trial such as the current PROTECT-ICD trial, which has a VT induction protocol similar to our study (31). Gatzoulis et al have also shown the utility of EPS after STEMI in a population with LVEF >40% (32).…”

Effectiveness of 2014 ESC HCM-Risk-SCD score in prediction of appropriate implantable-cardioverter-defibrillator shocks

“…Our study highlights the clinical need to improve SCD stratification to better select HCM patients for ICD implantation in both pediatric and adult ages 5 . In fact, previous retrospective studies evaluating the reliability of the European score have advocated its critical lack of sensibility over specificity 6,7 . Indeed, the HCM-Risk-SCD score does not take into account many clinical and morphological HCM features, which have been recently recognized as salient, 4 such as the extent of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR), the detection of left ventricular (LV) aneurysms and the presence of anomalous blood pressure responses during exercise test.…”

“…5 In fact, previous retrospective studies evaluating the reliability of the European score have advocated its critical lack of sensibility over specificity. 6,7 Indeed, the HCM-Risk-SCD score does not take into account many clinical and morphological HCM features, which have been recently recognized as salient, 4 such as the extent of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR), the detection of left ventricular (LV) aneurysms and the presence of anomalous blood pressure responses during exercise test. In our study population, three patients who experienced appropriate shocks accounted for a score of less than 4%; therefore they should not have been implanted according to the European Guidelines.…”

Editorial: Strategies to improve management of ventricular tachycardias

“…Many patients with an LVEF of less than 35% will never experience life-threatening arrhythmias whereas myocardial infarct scars can be severely arrhythmogenic in the presence of preserved or mildly reduced LVEF. Non-invasive studies combined with invasive programmed stimulation may help to identify patients at high risk in this specific group of patients (4). Advanced imaging techniques, in particular cardiac magnetic resonance imaging (CMR) might improve risk stratification in patients with an ischemic arrhythmic substrate.…”