title: Validation of the 2014 European Society of Cardiology Sudden Cardiac Death Risk Prediction Model in Hypertrophic Cardiomyopathy in a Reference Center in South America.
abstract: Sudden cardiac death (SCD) is a common cause of death in hypertrophic cardiomyopathy (HC). Our aim was to conduct an external and independent validation in South America of the 2014 European Society of Cardiology (ESC) SCD risk prediction model to identify patients requiring an implantable cardioverter defibrillator. This study included 502 consecutive patients with HC followed from March, 1993 to December, 2014. A combined end point of SCD or appropriate implantable cardioverter defibrillator therapy was assessed. For the quantitative estimation of individual 5-year SCD risk, we used the formula: 1 - 0.998(exp(Prognostic index)). Our database also included the abnormal blood pressure response to exercise as a risk marker. We analyzed the 3 categories of 5-year risk proposed by the ESC: low risk (LR) <4%; intermediate risk (IR) ≥4% to <6%, and high risk (HR) ≥6%. The LR group included 387 patients (77%); the IR group 39 (8%); and the HR group 76 (15%). Fourteen patients (3%) had SCD/appropriate implantable cardioverter defibrillator therapy (LR: 0%; IR: 2 of 39 [5%]; and HR: 12 of 76 [16%]). In a receiver-operating characteristic curve, the new model proved to be an excellent predictor because the area under the curve for the estimated risk is 0.925 (statistical C: 0.925; 95% CI 0.8884 to 0.9539, p <0.0001). In conclusion, the SCD risk prediction model in HC proposed by the 2014 ESC guidelines was validated in our population and represents an improvement compared with previous approaches. A larger multicenter, independent and external validation of the model with long-term follow-up would be advisable.
authors.affiliation: Department of Cardiology, Ambulatory Medicine, Institute of Cardiology and Cardiovascular Surgery, Favaloro Foundation University Hospital, Buenos Aires, Argentina. Electronic address: afernandez@ffavaloro.org.
authors.forename: Adrián
authors.initials: A
authors.lastname: Fernández
authors.affiliation: Department of Cardiology, Ambulatory Medicine, Institute of Cardiology and Cardiovascular Surgery, Favaloro Foundation University Hospital, Buenos Aires, Argentina.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Quiroga
authors.affiliation: Department of Cardiology, Echocardiography Laboratory, Institute of Cardiology and Cardiovascular Surgery, Favaloro Foundation University Hospital, Buenos Aires, Argentina.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Ochoa
authors.affiliation: Department of Cardiology, Electrophysiology Division, Institute of Cardiology and Cardiovascular Surgery, Favaloro Foundation University Hospital, Buenos Aires, Argentina.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Mysuta
authors.affiliation: Department of Cardiology, Ambulatory Medicine, Institute of Cardiology and Cardiovascular Surgery, Favaloro Foundation University Hospital, Buenos Aires, Argentina.
authors.forename: José Horacio
authors.initials: JH
authors.lastname: Casabé
authors.affiliation: Department of Cardiology, Basic Electrophysiology Laboratory, Institute of Cardiology and Cardiovascular Surgery, Favaloro Foundation University Hospital, Buenos Aires, Argentina.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Biagetti
authors.affiliation: Department of Cardiology, Echocardiography Laboratory, Institute of Cardiology and Cardiovascular Surgery, Favaloro Foundation University Hospital, Buenos Aires, Argentina.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Guevara
authors.affiliation: Department of Cardiology, Thoracic Transplantation, Favaloro Foundation University Hospital, Institute of Cardiology and Cardiovascular Surgery, Buenos Aires, Argentina.
authors.forename: Liliana E
authors.initials: LE
authors.lastname: Favaloro
authors.affiliation: Department of Cardiology, Echocardiography Laboratory, Institute of Cardiology and Cardiovascular Surgery, Favaloro Foundation University Hospital, Buenos Aires, Argentina.
authors.forename: Agostina M
authors.initials: AM
authors.lastname: Fava
authors.affiliation: Department of Cardiology, Electrophysiology Division, Institute of Cardiology and Cardiovascular Surgery, Favaloro Foundation University Hospital, Buenos Aires, Argentina.
authors.forename: Néstor
authors.initials: N
authors.lastname: Galizio
mesh_terms: D000328:Adult; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000401:mortality* / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D013020:South America; D055815:Young Adult