Key result
Myocardial fibrosis predicts ~243% greater risk of severe arrhythmias in HCM.
Why the study?
Hypertrophic cardiomyopathy is associated with sudden death, and an updated evaluation of risk markers emphasizing myocardial fibrosis was needed.
Does myocardial fibrosis and other risk markers predict severe arrhythmic outcomes in patients with hypertrophic cardiomyopathy?
Meta-Analysis (n=14,901)
Does myocardial fibrosis and other risk markers predict severe arrhythmic outcomes in patients with hypertrophic cardiomyopathy?
Effect estimate: RR 3.43 (95% CI 1.95-6.03)
Myocardial fibrosis is a strong predictor of severe arrhythmic outcomes and sudden death in patients with hypertrophic cardiomyopathy, highlighting the need to incorporate it into risk prediction models.
Supports integrating fibrosis assessment into hypertrophic cardiomyopathy arrhythmic risk models; reinforces its primacy among predictors.
BACKGROUND: Hypertrophic cardiomyopathy (HCM) is associated with sudden death (SD). Myocardial fibrosis is reportedly correlated with SD. OBJECTIVE: We performed a systematic review with meta-analysis, updating the risk markers (RMs) in HCM emphasizing myocardial fibrosis. METHODS: We reviewed HCM studies that addressed severe arrhythmic outcomes and the certain RMs: SD family history, severe ventricular hypertrophy, unexplained syncope, non-sustained ventricular tachycardia (NSVT) on 24-hour Holter monitoring, abnormal blood pressure response to exercise (ABPRE), myocardial fibrosis and left ventricular outflow tract obstruction (LVOTO) in the MEDLINE, LILACS, and SciELO databases. We used relative risks (RRs) as an effect measure and random models for the analysis. The level of significance was set at p < 0.05. RESULTS: Twenty-one studies were selected (14,901 patients aged 45 ± 16 years; men, 62.8%). Myocardial fibrosis was the major RISK MARKER (RR, 3.43; 95% CI, 1.95-6.03). The other RMs, except for LVOTO, were also predictors: SD family history (RR, 1.75; 95% CI, 1.39-2.20), severe ventricular hypertrophy (RR, 1.86; 95% CI, 1.26-2.74), unexplained syncope (RR, 2.27; 95% CI, 1.69-3.07), NSVT (RR, 2.79; 95% CI, 2.29-3.41), and ABPRE (RR, 1.53; 95% CI, 1.12-2.08). CONCLUSIONS: We confirmed the association of myocardial fibrosis and other RMs with severe arrhythmic outcomes in HCM and emphasize the need for new prediction models in managing these patients.
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Bittencourt et al. (2019) conducted a meta-analysis in Hypertrophic cardiomyopathy (HCM) (n=14,901). Myocardial fibrosis was evaluated on Severe arrhythmic outcomes (RR 3.43, 95% CI 1.95-6.03). Myocardial fibrosis was a major predictor of severe arrhythmic outcomes in patients with hypertrophic cardiomyopathy (RR 3.43; 95% CI 1.95-6.03).
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