Comparison of the new risk prediction model (HCM Risk-SCD) and classic risk factors for sudden death in patients with hypertrophic cardiomyopathy and defibrillator

Ruíz-Salas, Amalio; García‐Pinilla, José Manuel; Cabrera-Bueno, Fernando; Fernández-Pastor, Julia; Peña-Hernández, José; Medina-Palomo, Carmen; Barrera-Cordero, Alberto; Teresa, Eduardo de; Alzueta, Javier

doi:10.1093/europace/euv079

Cited by 24 publications

(11 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similarly, inappropriate shocks occurred at a rate of 4.9% (95% CI: 3.9-6.0) per year (I 2 =75%) ( Figure 3). Among six studies (7,8,10,25,29,33), heart transplant was required in 1.6% of patients per year. The annual incidence of lead malfunction and lead displacement was 1.4% (95% CI: 0.8-2.5) and 1.3% (95% CI: 0.8-2.0) respectively.…”

Section: Resultsmentioning

confidence: 99%

“…The model predicts that one SCD will be prevented every 5 years if 16 patients with a 5-year risk of SCD that is greater than or equal to 4% are given ICD therapy (45). Validation studies have suggested that the new model is superior to traditional models based on bivariate risk factors (29,46). Future studies into the role of cardiac magnetic resonance imaging may further improve the current risk models.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy: an updated systematic review and meta-analysis of outcomes and complications

Wang¹,

Xie²,

Tjahjono³

et al. 2017

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

Background: Since the introduction of the implantable cardioverter-defibrillator (ICD) in patients with hypertrophic cardiomyopathy (HCM), the incidence of sudden cardiac death (SCD) has been significantly reduced. Given its widespread use, it is important to identify the outcomes associated with ICD use in patients with HCM. The present paper is a systematic review and meta-analysis of the rates of appropriate and inappropriate interventions, mortality, and device complications in HCM patients with an ICD.Methods: We conducted a systematic review and meta-analysis on 27 studies reporting outcomes and complications after ICD implantation in patients with HCM. ICD interventions, device complications, and mortality were extracted for analysis.Results: A total of 3,797 patients with HCM and ICD implantation were included (mean age, 44.5 years; 63% male), of which 83% of patients had an ICD for primary prevention of SCD. The cardiac mortality was 0.9% (95% CI: 0.7-1.3) per year and non-cardiac mortality was 0.8% (95% CI: 0.6-1.2) per year. Annualized appropriate intervention rate was 4.8% and annualized inappropriate intervention was 4.9%. The annual incidence of lead malfunction, lead displacement and infection was 1.4%, 1.3%, and 1.1%, respectively.Conclusions: ICD use in patients with HCM produces low rates of cardiac and non-cardiac mortality, and an appropriate intervention rate of 4.8% per year. However, moderate rates of inappropriate intervention and device complications warrant careful patient selection in order to optimize the risk to benefit ratio in this select group of patients.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy: an updated systematic review and meta-analysis of outcomes and complications

Wang¹,

Xie²,

Tjahjono³

et al. 2017

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

show abstract

“…Validation studies have suggested that the new model is superior to traditional models based on bivariate risk factors 31,32 , and current clinical practice guidelines 33 , has included the HCM Risk-SCD model on their recommendations of prevention of sudden cardiac death as a method of estimating risk of SCD at 5 years in primary prevention ( Figure 7 ).…”

Section: Evidence Of Icd In Hcmmentioning

confidence: 99%

Implantable cardioverter–defibrillator in hypertrophic cardiomyopathy

Sanchez

Fernández‐Lozano

2018

gcsp

View full text Add to dashboard Cite

Sudden cardiac death (SCD) is the most devastating complication in hypertrophic cardiomyopathy (HCM). The implantable cardioverter–defibrillator (ICD) has proven to be effective in SCD prevention in several clinical scenarios. In HCM population, it has demonstrated to successfully abort life-threatening ventricular arrhythmias despite the extreme morphology characteristic of HCM, often with massive degrees of left ventricular hypertrophy and/or LV outflow tract obstruction. Studies showed a high rate of appropriate intervention in secondary prevention and in primary prevention of patients considered at high risk. This appropriate intervention rate is even more significant considering the young and otherwise healthy patients that compose HCM population. Since SCD incidence in HCM is relatively low, optimal identification of patients at high risk is crucial. Classical strategy of risk stratification based on clinical risk factors has several limitations and has proven to overestimate risk. A new risk prediction model that provides individual 5-year estimated risk appears to be superior to traditional models based on bivariate risk factors. Perioperative complications seem to be similar to those related to the implant of other cardiac devices, while long-term complications have been traditionally in the spotlight. HCM patients are considered more vulnerable to ICD-related complications and inappropriate ICD therapy because of their young age at implant and increased prevalence of atrial fibrillation, but long-term follow-up data on ICD-related complications in general practice is limited. The subcutaneous implantable cardioverter defibrillator seems to be a safe and effective alternative in HCM, although long-term data are scarce.

show abstract

“…Las recomendaciones de implante de DAI están basadas en estudios observacionales, retrospectivos y de cohorte que miden la asociación de ciertas características clínicas con el pronóstico (5) . Esta situación nos plantea una clara diferencia con las recomendaciones para prevención primaria de MSC en las miocardiopatías isquémica y dilatada, donde la indicación de DAI está basada en estudios clínicos randomizados prospectivos que le confieren una evidencia más sólida (33)(34)(35) .…”

Section: Modelos Para Estimar Muerte Súbita Cardíacaunclassified

Miocardiopatía hipertrófica: ¿cómo evaluamos en 2018 el riesgo de muerte súbita?

et al. 2018

View full text Add to dashboard Cite

La miocardiopatía hipertrófica (MCH) es una enfermedad frecuente del miocardio, asociada a muerte súbita cardíaca (MSC). Las principales causas de muerte en MCH son la MSC, la insuficiencia cardíaca y el tromboembolismo. La fibrilación ventricular (FV) es la causa más común de MSC, seguida de asistolia, actividad eléctrica sin pulso y bloqueo auriculoventricular completo. El sustrato de estas arritmias complejas es la hipertrofia asociada a desorganización miofibrilar y fibrosis, que facilitan el desarrollo de arritmias reentrantes y secundarias a actividad desencadenada. Dado que la FV puede ser tratada con el implante de un desfibrilador automático implantable (DAI), la identificación de los pacientes que presentan mayor riesgo se transforma en la principal preocupación del cardiólogo tratante. La indicación de implante de DAI es clara en la prevención secundaria de MSC, pero es compleja en el resto de los pacientes que no han presentado FV o taquicardia ventricular sostenida, lo que configura la prevención primaria de MSC. Debemos estratificar la MCH con el uso de los factores de riesgo derivados de datos clínicos y estudios complementarios. Los principales factores de riesgo relacionados a MSC son: edad temprana al diagnóstico, antecedentes heredofamiliares de MSC, síncope inexplicado, taquicardia ventricular no sostenida, hipotensión arterial inducida durante la prueba de esfuerzo, obstrucción del tracto de salida del ventrículo izquierdo, hipertrofia ventricular izquierda severa, agrandamiento auricular izquierdo y captación de realce tardío en la resonancia magnética. El uso adecuado de los dos principales modelos de estratificación de riesgo actualmente disponibles nos ayuda a estimar el riesgo individual en cada paciente y proceder en consecuencia.

show abstract

Comparison of the new risk prediction model (HCM Risk-SCD) and classic risk factors for sudden death in patients with hypertrophic cardiomyopathy and defibrillator

Abstract: During an average follow-up of 4 years, 16.67% presented appropriate events (4.16%/year). HCM Risk-SCD predicted the onset of events more suitably than classic risk factors.

Cited by 24 publications

References 11 publications

Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy: an updated systematic review and meta-analysis of outcomes and complications

Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy: an updated systematic review and meta-analysis of outcomes and complications

Implantable cardioverter–defibrillator in hypertrophic cardiomyopathy

Miocardiopatía hipertrófica: ¿cómo evaluamos en 2018 el riesgo de muerte súbita?

Contact Info

Product

Resources

About