Importance of newer cardiac magnetic resonance-based risk markers for sudden death prevention in hypertrophic cardiomyopathy: An international multicenter study.

Autor:	Rowin EJ; HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts; Chanin T. Mast HCM Center, Morristown Medical Center, Morristown, New Jersey. Electronic address: erowin@tuftsmedicalcenter.org., Maron MS; HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts; Chanin T. Mast HCM Center, Morristown Medical Center, Morristown, New Jersey., Adler A; Division of Cardiology, Peter Munk Cardiac Centre, University Health Network and Department of Medicine, University of Toronto, Toronto, Ontario, Canada., Albano AJ; Division of Cardiology, Spectrum Health, Grand Rapids, Michigan., Varnava AM; Department of Cardiology, Imperial College, London, United Kingdom., Spears D; Division of Cardiology, Peter Munk Cardiac Centre, University Health Network and Department of Medicine, University of Toronto, Toronto, Ontario, Canada., Marsy D; Division of Cardiology, Spectrum Health, Grand Rapids, Michigan., Heitner SB; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon., Cohen E; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon., Leong KMW; Department of Cardiology, Imperial College, London, United Kingdom., Winters SL; Chanin T. Mast HCM Center, Morristown Medical Center, Morristown, New Jersey., Martinez MW; Chanin T. Mast HCM Center, Morristown Medical Center, Morristown, New Jersey., Koethe BC; HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts., Rakowski H; Division of Cardiology, Peter Munk Cardiac Centre, University Health Network and Department of Medicine, University of Toronto, Toronto, Ontario, Canada., Maron BJ; HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2022 May; Vol. 19 (5), pp. 782-789. Date of Electronic Publication: 2021 Dec 18.
DOI:	10.1016/j.hrthm.2021.12.017
Abstrakt:	Background: The sudden death (SD) risk stratification algorithm in hypertrophic cardiomyopathy (HCM) has evolved, underscored recently by novel cardiac magnetic resonance (CMR)-based risk markers (left ventricular apical aneurysm, extensive late gadolinium enhancement, and end-stage disease with systolic dysfunction) incorporated into the 2020 American Heart Association (AHA)/American College of Cardiology (ACC) HCM guidelines. Objective: The purpose of this study was to assess the specific impact of newer, predominantly CMR-based risk markers in a large multicenter HCM population that underwent primary prevention implantable cardioverter-defibrillator (ICD) implants. Methods: Longitudinal study of 1149 consecutive HCM patients from 6 North American and European HCM centers prospectively judged to be at high SD risk based on ≥1 AHA/ACC individual risk markers and prophylactically implanted with an ICD was performed. European Society of Cardiology (ESC) risk score was retrospectively analyzed with respect to the known clinical outcome. Results: Of 1149 patients with an ICD, 162 (14%) experienced device therapy terminating ventricular tachycardia/ventricular fibrillation 4.6 ± 4.2 years after implant. CMR-based markers solely or in combination led to ICD implantation in 49 of the 162 patients (30%) experiencing device therapy. Particularly low ESC scores (<4%/5 years) would have excluded an ESC ICD recommendation for 67 patients who nevertheless experienced appropriate ICD therapy, including 26 with the CMR-based risk markers not part of the ESC formula. Conclusion: Identification and incorporation of novel guideline-supported CMR-based risk markers enhance selection of HCM patients for SD prevention with ICDs. Absence of CMR-based markers from the ESC risk score accounts, in part, for it not identifying many HCM patients with SD events. These data support inclusion of CMR as a routine part of HCM patient evaluation and risk stratification. (Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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