Effectiveness of the 2014 European Society of Cardiology guideline on sudden cardiac death in hypertrophic cardiomyopathy: a systematic review and meta-analysis

Abstract

ObjectiveIn 2014, the European Society of Cardiology (ESC) recommended the use of a novel risk prediction model (HCM Risk-SCD) to guide use of implantable cardioverter defibrillators (ICD) for the primary prevention of sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). We sought to determine the performance of HCM Risk-SCD by conducting a systematic review and meta-analysis of articles reporting on the prevalence of SCD within 5 years of evaluation in low, intermediate and high-risk patients as defined by the 2014 guidelines (predicted risk <4%, 4%–<6% and ≥6%, respectively).MethodsThe protocol was registered with PROSPERO (registration number: CRD42017064203). MEDLINE and manual searches for papers published from October 2014 to December 2017 were performed. Longitudinal, observational cohorts of unselected adult patients, without history of cardiac arrest were considered. The original HCM Risk-SCD development study was included a priori. Data were pooled using a random effects model.ResultsSix (0.9%) out of 653 independent publications identified by the initial search were included. The calculated 5-year risk of SCD was reported in 7291 individuals (70% low, 15% intermediate; 15% high risk) with 184 (2.5%) SCD endpoints within 5 years of baseline evaluation. Most SCD endpoints (68%) occurred in patients with an estimated 5-year risk of ≥4% who formed 30% of the total study cohort. Using the random effects method, the pooled prevalence of SCD endpoints was 1.01% (95% CI 0.52 to 1.61) in low-risk patients, 2.43% (95% CI 1.23 to 3.92) in intermediate and 8.4% (95% CI 6.68 to 10.25) in high-risk patients.ConclusionsThis meta-analysis demonstrates that HCM Risk-SCD provides accurate risk estimations that can be used to guide ICD therapy in accordance with the 2014 ESC guidelines.Registration numberPROSPERO CRD42017064203;Pre-results.

Validation of the hypertrophic cardiomyopathy risk-sudden cardiac death calculator in Asians

“…Finally, a large multicentre, international study proved the positive impact of the HCM Risk-SCD prediction model in clinical decision-making 9. In addition, a systematic review and meta-analysis involving 7291 patients with HCM again recently reported the clinical value of the HCM Risk-SCD calculator 16…”

Discordância entre Diretrizes Internacionais sobre Critérios de Prevenção Primária de Morte Súbita na Cardiomiopatia Hipertrófica

“…Nevertheless, the metanalysis of six studies conducted with 7,291 patients demonstrates that in most cases, the five-year SCD risk is properly estimated with the ESC score. 33 The European score settles the stratification for SCD using a rigid statistical model in a complex disease with unpredictable course. Methodological limitations may depend on left atrial evaluation with diameter, LVOT obstruction with Valsalva maneuver, and on exclusion of myocardial ischemia, late gadolinium enhancement and LV apical aneurysm.…”

Sleep Disordered Breathing in Hypertrophic Cardiomyopathy—Current State and Future Directions

“…The HCM risk SCD [66] is a risk prediction model for HCM that had been used to direct the use of implantable cardioverter defibrillators (ICDs) for the prevention of SCD. The risk prediction has been extensively tested for validation and shown to be the best available risk predictor [67,68]. As of now, OSA is not part of the ESC risk calculator, but it could become a part of the prediction model in the future when studies could potentially show evidence of OSA increasing SCD risk.…”