Validation of the Risk Stratification for Sudden Cardiac Death in Chinese Patients With Hypertrophic Cardiomyopathy

Accurate identification of hypertrophic car-diomyopathy (HCM) patients at high risk of sudden cardiac death (SCD) event is challenging. The objec-tive of this study was to validate the three SCD risk stratifications recommended by the 2014 European Society of Cardiology (ESC) guideline, the 2020 Amer-ican Heart Association /American College of Cardiol-ogy (AHA/ACC) guideline, and the 2022 ESC guideline in Chinese patients with HCM. Our study population are made up of a cohort of 856 HCM patients without prior SCD events. The endpoint was defined as SCD or equivalent events (successful resuscita-tion after cardiac arrest or appropriate ICD shock for ventricular tachycardia or ventricular fibrillation). Dur-ing a median follow-up of 43 months, SCD endpoints occurred in 44 (5.1%) patients. A total of 34 (77.3%) patients suffering from SCD events were classified cor-rectly into high-risk groups by the 2020 AHA/ACC guideline, 27(61.4%) by the 2022 ESC guideline, and 13 (29.6%) by the 2014 ESC guideline. The C-statistic of the 2020 AHA/ACC guideline was 0.68 (95% CI, 0.60-0.76), which performed better than the 2022 ESC guide-line (0.65: 95% CI, 0.56-0.73), and the 2014 ESC guide-line (0.58: 95% CI, 0.48-0.67). The 2020 AHA/ACC guideline displayed better discrimination for SCD risk stratification in Chinese HCM patients than the other two guidelines, with a higher sensitivity but lower speci-ficity. (Curr Probl Cardiol 2023;48:101875.)

Automated summary

This study aimed to validate the effectiveness of the 2014 ESC guideline, 2020 AHA/ACC guideline, and 2022 ESC guideline in stratifying the SCD risk of Chinese HCM patients. The results showed that the 2020 AHA/ACC guideline performed better in identifying high-risk groups and had higher sensitivity for SCD risk stratification in Chinese HCM patients than the other two guidelines. The 2014 ESC guideline had lower accuracy.