ABC | Volume 115, Nº2, August 2020

Original Article Mattos BP et al. Sudden death in hypertrophic cardiomyopathy Arq Bras Cardiol. 2020; 115(2):197-204 Table 5 – Comparison of implantable cardioverter defibrillator recommendations between the 2011 American College of Cardiology Foundation/American Heart Association and the 2014 European Society of Cardiology guidelines 2014 ESC IIa IIb III n (%) 12 (14%) 11 (12%) 67 (74%) 2011 ACCF/AHA IIa 43(48%) 11(26%) 8(18%) 24(56%) IIb 3(3%) 0 3(100%) 0 III 44(49%) 1(2%) 0 43(98%) Kappa=0.355, P=0.0001 ACCF/AHA: American College of Cardiology Foundation/American Heart Association; ESC: European Society of Cardiology. Figure 1 – Discrepancy between the 2011 ACCF/AHA and the 2014 ESC guidelines on sudden cardiac death primary prevention in hypertrophic cardiomyopathy ICD = implantable cardioverter defibrillator, SCD = sudden cardiac death, HCM = hypertrophic cardiomyopathy, ACCF= American College of Cardiology Foundation, AHA = American Heart Association, ESC = European Society of Cardiology, NSVT = non-sustained ventricular tachycardia, BP = blood pressure; ¹Modifier factors: 1. Left ventricular outflow tract gradient ≥30 mmHg; 2. Late gadolineum enhancement on cardiac magnetic resonance; 3.Left ventricular apical aneurysm; 4. Malignant genetic mutation. ICD primary prevention for SCD 90 patients with HCM ACCF/AHA 2011 ESC 2014 IIa Family history of sudden cardiac death IIa HCM-Risk SCD ≥ 6% Maximal left ventricular wall thickness ≥30mm IIb HCM-Risk SCD 6 < and ≥ 4 % Recent unexplained syncope NSVT or abnormal BP response to exercise associated with other risk or modifier factors¹ III HCM-Risk SCD < 4 % IIb NSVT or abnormal BP response to exercise HCM-Risk SCD score: 1 – 0.998 exp (Prognostic index). Prognostic index = [0.15939858 x maximal wall thickness (mm)] - [0.00294271 x maximal wall thickness² (mm²)] + [0.0259082 x left atrial diameter (mm)] + [0.00446131 x maximal (rest/Valsalva) left ventricular outflow tract gradient (mm Hg)] + [0.4583082 x family history of sudden cardiac death] + [0.82639195 x NSVT] + [0.71650361 x unexplained syncope] - [0.01799934 x age at clinical evaluation (years)]. III Absence of risk factors Low agreement (Kappa = 0.355) Change of the ICD indication class in 36% 2011 ACCF/AHA IIa 48% 2014 ESC IIa 26% IIb 18% III 56% 201