Russian Heart Failure Journal 2013year Prediction of sudden cardiac death in hypertrophic cardiomyopathy: Identifying high-risk patients


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2013/№6

Prediction of sudden cardiac death in hypertrophic cardiomyopathy: Identifying high-risk patients

Komissarova S. M., Melnikova O. P., Gevorkyan T. T., Ustinova I. B., Sevruk I. V., Krasko O. V., Mrochek A. G.

Keywords: sudden cardiac death, HCMP, prognosis, risk factors

DOI: 10.18087/rhfj.2013.6.1864

Background. Prediction of sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCMP) remains a complicated and not completely solved problem. Factors have been suggested, which allow identifying HCMP patients with high risk of SCD. Aim. Evaluating the effect of echoCG and ECG parameters on prediction of SCD in patients with HCMP. Materials and methods. Clinical demographic and instrumental data were analyzed for 173 patients with HCMP (111 males and 62 females; median age, 45 years) admitted to the Republican Scientific and Practical Center “Cardiology” from 2007 through 2013. Results. Univariate analysis identified statistically significant differences between groups of patients with presence or absence of cardiac events by the following parameters: LV end-systolic dimensions (ESD) (р<0.01), pulmonary artery systolic pressure (PASP) (р<0.005), deceleration time (DT) of LV early diastolic filling velocity (p<0.01), QT dispersion (QTd) (р<0.05), and presence of unstable ventricular tachycardia (USVT) (р<0.009). Conclusion. Multivariate analysis with logistic regression showed that SCD RFs for the studied group of patients included ESD ≤27 mm (OR=8.75 (2.03÷53.42)), DT<170 msec (OR=11.62 (2.24÷106.09)), QTd ≥50 msec (OR=11.56 (2.84÷63.30)), and USVT episodes (OR=5.2 (51.25÷24.84)). Based on results of the modeling, a nomogram was created for calculating a probability of cardiac events in patients with HCMP.
  1. Maron BJ, McKenna WJ, Danielson GK et al. American College of Cardiology / European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines. J Am Coll Cardiol. 2003;42 (9):1687–1713.
  2. Elliott PM, Poloniecki J, Dickie S et al. Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. J Am Coll Cardiol. 2000;36 (7):2212–2218.
  3. Maki S, Ikeda H, Muro A et al. Predictors of sudden cardiac death in hypertrophic cardiomyopathy. Am J Cardiol. 1998;82 (6):774–778.
  4. Gersh BJ, Maron BJ, Bonow RO et al. 2011 ACCF / AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation / American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2011;58 (25):e212–260.
  5. Monserrat L, Elliott PM, Gimeno JR et al. Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy: an independent marker of sudden death risk in young patients. J Am Coll Cardiol. 2003;42 (5):873–879.
  6. Maron BJ, Spirito P, Shen WK et al. Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy. JAMA. 2007;298 (4):405–412.
  7. Elliott PM, Sharma S, Varnava A et al. Survival after cardiac arrest or sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 1999;33 (6):1596–1601.
  8. Cecchi F, Maron BJ, Epstein SE. Long-term outcome of patients with hypertrophic cardiomyopathy successfully resuscitated after cardiac arrest. J Am Coll Cardiol. 1989;13 (6):1283–1288.
  9. Kofflard MJ, Ten Cate FJ, van der Lee C, van Domburg RT. Hypertrophic cardiomyopathy in a large community-based population: clinical outcome and identification of risk factors for sudden cardiac death and clinical deterioration. J Am Coll Cardiol. 2003;41 (6):987–993.
  10. Fay WP, Taliercio CP, Ilstrup DM et al. Natural history of hypertrophic cardiomyopathy in the elderly. J Am Coll Cardiol. 1990;16 (4):821–826.
  11. Cannan CR, Reeder GS, Bailey KR et al. Natural history of hypertrophic cardiomyopathy: a population-based study, 1976 through 1990. Circulation. 1995;92 (9):2488–2495.
  12. Spirito P, Autore C, Rapezzi C et al. Syncope and risk of sudden death in hypertrophic cardiomyopathy. Circulation. 2009;119 (13):1703–1710.
  13. Williams L, Frenneaux M. Syncope in hypertrophic cardiomyo­pathy: mechanisms and consequences for treatment. Europace. 2007;9 (9):817–822.
  14. Nienaber CA, Hiller S, Spielmann RP et al. Syncope in hypertrophic cardiomyopathy: Multivariate analysis of prognostic determinants. J Am Coll Cardiol. 1990;15 (5):948–955.
  15. Spirito P, Bellone P, Harris KM et al. Magnitude of left ventricular hypertrophy and risk of sudden death in hypertrophic cardiomyopathy. N Engl J Med. 2000;342 (24):1778–1785.
  16. Olivotto I, Gistri R, Petrone P et al. Maximum left ventricular thickness and risk of sudden death in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2003;41 (2):315–321.
  17. Maron BJ, Piccininno M, Casey SA et al. Relation of extreme left ventricular hypertrophy to age in hypertrophic cardiomyopathy. Am J Cardiol. 2003;91 (5):626–628.
  18. Adabag AS, Casey SA, Kuskowski MA et al. Spectrum and prognostic significance of arrhythmias on ambulatory Holter electrocardiogram in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2005;45 (5):697–704.
  19. Gimeno JR, Tomé-Esteban M, Lofiego C et al. Exicise-induced ventricular arrhythmias and risk of sudden cardiac death in patients with hypertrophic cardiomyopathy. Eur Heart J. 2009;30 (21):2599–2605.
  20. DeLong ER, DeLong DM, Clarke-Pearson DL. Clarke-Pearson. Comparing the areas under two or more correlated receiver opera­ting characteristic curves: a nonparametric approach. Biometrics. 1988;44 (3):837–845.
  21. Firth D. Bias reduction of maximum likelihood estimates. Biometrika. 1993;80:27–38.
  22. Elliott PM, Gimeno JR, Tomé MT et al. Left ventricular outflow tract obstruction and sudden death risk in patients with hypertrophic cardiomyopathy. Eur Heart J. 2006;27 (16):1933–1941.
  23. Ommen SR, Shah PM, Tajik AJ. Left ventricular outflow tract obstruction in hypertrophic cardiomyopathy past, present and future. Heart. 2008;94 (10):1276–1281.
  24. Ommen SR, Maron BJ, Olivotto I et al. Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol. 2005;46 (3):470–476.
  25. Carasso S, Yang H, Woo A et al. Diastolic myocardial mechanics in hypertrophic cardiomyopathy. J Am Soc Echocardiogr. 2010;23 (2):164–171.
  26. Rakowski H, Carasso S. Quatifying diastolic function in hypertrophic cardiomyopathy: the ongoing search for the holy grail. Circulation. 2007;116 (23):2662–2665.
  27. Bayes de Luna A, Vinolas X. QT dispersion and heart rate variabi­lity. Eur Heart J. 1996;17 (2):165–166.
  28. Maron BJ, Leyhe MJ 3rd, Casey SA et al. Assessment of QT dispersion as a prognostic marker for sudden death in a regional nonreferred hypertrophic cardiomyopathy cohort. Am J Cardiol. 2001;87 (1):114–115, A9.
Komissarova S. M., Melnikova O. P., Gevorkyan T. T. et al. Prediction of sudden cardiac death in hypertrophic cardiomyopathy: Identifying high-risk patients. Russian Heart Failure Journal. 2013;14 (6):322-328

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