Low agreement among guidelines for primary prevention ICD recommendations in hypertrophic cardiomyopathy: Short title: Differing ICD recommendations in HCM.

Autor: Scolari FL; Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. Electronic address: fscolari@hcpa.edu.br., Garbin HI; Post-Graduation Program in Cardiology and Cardiovascular Sciences, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Carvalho GD; Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil., Rodrigues FT; Heart Failure and Cardiomyopathy Clinic, Hospital Pedro Ernesto, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil., de Menezes RA; Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Correia EB; Division of Cardiomyopathies, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil., Bittencourt MI; Heart Failure and Cardiomyopathy Clinic, Hospital Pedro Ernesto, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2024 Nov 16. Date of Electronic Publication: 2024 Nov 16.
DOI: 10.1016/j.amjcard.2024.11.007
Abstrakt: Background: Sudden cardiac death (SCD) risk stratification and primary prevention implantable cardioverter-defibrillator (ICD) recommendations are based on differing strategies in hypertrophic cardiomyopathy (HCM).
Objectives: The study aims on evaluating the impact of the 2023 European Society of Cardiology (ESC) guidelines on the 2014 ESC and the 2024 American Heart Association (AHA)/American College of Cardiology (ACC) systems regarding primary prevention ICD in HCM.
Methods: A HCM cohort of 200 patients in Brazil was assessed for SCD risk profile according to current guidelines. The agreement for primary prevention ICD recommendations was evaluated among different strategies. SCD and appropriate shock were defined as end-points.
Results: Among the 200 patients, 63 (31%) received a primary prevention ICD, with 10 (15.8%) receiving appropriate shocks. A low agreement was found among guidelines, Fleiss' Kappa 0.340 (95% CI 0.286-0.395), P<0.001. The European systems showed a moderate agreement. The 2024 AHA/ACC algorithm placed 58% of patients in class IIa, whereas only 29% achieved this recommendation with the 2023 ESC model. The end-points occurred in 8% over 9.4±6.5 years. The 2014 ESC showed the highest accuracy [77%, (95% CI 71-83)] and negative predictive value [96%, (95% CI 90-98)] in detecting patients in class IIa with primary end-points. However, all guidelines showed a low positive predictive value. The 2024 AHA/ACC classified the highest number of patients (81%) with the primary end-point as class IIa.
Conclusion: A low agreement was found among guidelines regarding primary prevention ICD recommendations in HCM, particularly between the 2023 ESC and 2024 AHA/ACC systems.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Fernando Luis Scolari reports financial support was provided by Clinics Hospital of Porto Alegre. Fernando Luis Scolari reports a relationship with Hospital de Clínicas de Porto Alegre that includes: employment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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