Differing strategies for sudden death prevention in hypertrophic cardiomyopathy

Figures

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  Figure 1. The ‘seesaw’ that governs ICD decision making in HCM. Risk stratification is a trade-off between preventing SD with ICDs and possible device-related complications. Shown here for American Heart Association/American College of Cardiology major risk marker strategy, using ≥1 risk factors in conjunction with clinical judgement and shared decision making, SDs are reduced (95% sensitivity), but concomitantly, the possibility of ICD complications (largely related to transvenous lead systems) are increased (specificity 78%). The seesaw for the European risk score would show a decrease in SDs (although more modest; sensitivity 33%) but with a significantly lower ICD complication rate (specificity 92%). HCM, hypertrophic cardiomyopathy; ICD, implanted cardioverter-defibrillator; SDs, sudden deaths.

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  Figure 2. Risk stratification and ICD decision making for high-risk HCM patients based on the American Heart Association/American College of Cardiology guideline major risk marker strategy. EF, ejection fraction; ICD, implantable cardioverter defibrillator; LGE, late gadolinium enhancement; LVH, left ventricular hypertrophy; NSVT, non-sustained ventricular tachycardia; SD, sudden death.

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  Figure 3. Sensitivity and specificity comparisons for the major risk marker and mathematical risk score strategies. SCD, sudden cardiac death.

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  Figure 4. Proportion of high-risk HCM patients with ICD therapy, relative to CMR-based or other risk markers. HCM, hypertrophic cardiomyopathy; LV, left ventricular; LGE, late gadolinium enhancement; NSVT, nonsustained ventricular tachycardia; SCD, sudden cardiac death.