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Predictors of implantable cardio-defibrillator activation in patients with hypertrophic cardiomyopathy at primary prevention of sudden cardiac death
Session:
Sessão de Posters 28 - Morte súbita cardíaca
Speaker:
Miguel Marques Antunes
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.4 Ventricular Arrhythmias and SCD - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Miguel Marques Antunes; André Ferreira; Pedro Garcia Brás; Inês Gracio Almeida; José Viegas; Isabel Cardoso; Guilherme Portugal; Pedro Silva Cunha; Ana Lousinha; Rui Cruz Ferreira; Mário Martins Oliveira; Sílvia Aguiar Rosa
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Background: Hypertrophic cardiomyopathy (HCM) is a prevalent and potentially life-threatening condition. Albeit current advances in its treatment and characterization, prediction and prevention of sudden cardiac death (SCD) and ventricular arrythmias (VA) remain sub-optimal. Implantable cardioverter-defibrillators (ICDs) have robust evidence supporting their use in the reduction of cardiovascular mortality in patients (P) in secondary prevention. However, the decision process of using these devices in primary prevention remains a matter of debate. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Objective: To evaluate the prevalence and predictors of SCD and VA in a population of HCM P with an ICD in primary prevention. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: We retrospectively analysed data from P followed at a Cardiomyopathy Clinic in which a decision to implant an ICD in primary prevention was made. P characteristics, remote monitoring, echocardiographic, and cardiac magnetic resonance (CMR) imaging data were recorded. We stratified the P according to their baseline risk following the HCM SCD risk prediction calculator, and we recorded factors that are known to increase SCD risk, such as the presence of >15% late gadolinium enhancement in CMR and a LVEF <50% (Table 1). <span style="background-color:white"><span style="color:black">Continuous variables were reported as mean ± SD or median and IQR depending on data distribution pattern and categorical data as frequencies and percentages. A Kaplan-Meier curve was derived from the survival data. </span></span>We performed a time-to-event analysis using a Cox proportional-hazards regression model, to determine predictors of appropriate ICD therapy. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: We included a total of 42 P with a median age of 56 [46-67] years, 26 (46%) of which were male (Table 1). The median HCM SCD risk score was 4.75 [3.33-5.9], classifying as an intermediate-risk group. Study follow-up amounted to a total of 26 568 days (72 years) at risk, and an average of 1.7 patient/years (Table 1). The largest follow-up period was 1401 days (3.8 years) (Figure 1). There were 4 (10%) ICD therapy interventions recorded – 3 shocks and 1 anti-tachycardia pacing. ICD activation rhythms consisted of ventricular fibrillation (n=1) and ventricular tachycardia (n=3) (Table 2). We tested the separate individual components of the HCM SCD risk score and the presence of LGE>15% (Table 1), and found no association between these and ICD therapies. The HCM SCD risk score correlated positively with the incidence of arrhythmic events, with an HR 1.48 (95%CI 1.09-2.1, p=0.019), with a 48% increase in baseline risk of events per 1% increase in the risk score. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion: In our patient cohort, retrospective classification of ICD risk classification led to an estimated 4.5% median risk at 5 years. At an average 1.7 patient/year follow-up, we have found a 10% incidence of ICD activation. The HCM Risk Score was a statistically significant predictor of ICD activation.</span></span></p>
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