Figure 6 Risk stratification in hypertrophic cardiomyopathy (HCM)

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Presentation transcript:

Figure 6 Risk stratification in hypertrophic cardiomyopathy (HCM) Figure 6 | Risk stratification in hypertrophic cardiomyopathy (HCM)13,14,15,134,135. *Inherent limitations of the 2003 algorithm include the assignment of equal weighting to all five principal risk factors without regard for different effect sizes, and assumption of cumulative risk via a simple additive model, without allowing for the possibilities of multiplicative interaction, specific interactions between markers, or modification by ancillary markers. ‡Some of the ancillary predictors (for example, paced electrogram fractionation) were published subsequent to the 2003 consensus guidelines. §Left ventricular (LV) maximal wall thickness (MWT) is entered as a continuous variable into HCM-Risk-SCD. By contrast, both the 2003 consensus and 2011 US guidelines dichotomize MWT, with the cut-off for high risk arbitrary set at ≥30 mm. ||Three or more consecutive beats at ≥120 bpm. ¶Failure of systolic blood pressure (BP) to rise by ≥20 mmHg during maximal upright exercise testing; the prognostic value is greatest in those aged <40 years. #Age had a negative regression coefficient in HCM-risk-SCD. **LVOT gradient is entered as a continuous variable into HCM-Risk-SCD, whereas other studies and algorithms generally use ≥30 mmHg as the cut-off. ‡‡Paced electrocardiogram fractionation analysis was evaluated in 179 patients with HCM followed up for a mean of 4.3 years and reported to have a C-statistic of 0.88 for prediction of sudden cardiac death (SCD) or resuscitated ventricular fibrillation arrest. CMR, cardiac magnetic resonance; ICD, implantable cardioverter–defibrillator; LA, left atrial; LGE, late gadolinium enhancement; VT, ventricular tachycardia. Sen-Chowdhry, S. et al. (2016) Update on hypertrophic cardiomyopathy and a guide to the guidelines Nat. Rev. Cardiol. doi:10.1038/nrcardio.2016.140