Abstract
Background
We performed a systematic review and meta-analysis to assess the discrimination performance
of the 2014 European Society of Cardiology (ESC) sudden cardiac death (SCD) risk-prediction
model for hypertrophic cardiomyopathy (HCM).
Methods
We searched the PubMed, Embase and Web of Science, CNKI, WanFang, and China Biology
Medicine disc (CBMdisc) databases for English and Chinese articles validating the
risk model. The model’s discrimination performance with cutoff points of 4% and 6%
based on extracted information was calculated. The extracted C statistic and calculated
area under the curve (AUC) with 95% confidence intervals (CIs) of all studies were
weighted and summarized. Heterogeneity was quantified through I2 statistics; sensitivity analysis and publication bias were assessed with Egger’s
test.
Results
We included 13 studies validating the model’s usefulness. We concluded that the model
has excellent specificity, although it has poor sensitivity when setting a recommended
cutoff value of 6% for identifying high-risk patients with HCM. In addition, there
was moderate discrimination value (global C statistic = 0.75, 95% CI, 0.67-0.83; cutoff
point of ≥ 4%; AUC = 0.69, 95% CI, 0.62-0.75; cutoff point of ≥ 6%; AUC = 0.65, 95%
CI, 0.59-0.72). Subgroup analysis by region showed slightly weaker predictive ability
for North America. There was no significant publication bias (all P > 0.05); sensitivity analysis did not change the results significantly.
Conclusions
The 2014 ESC HCM SCD risk-prediction model has excellent specificity and poor sensitivity
and has moderate discrimination performance. In addition, it may have lower prediction
value for North America compared with other regions.
Résumé
Introduction
Nous avons réalisé une revue systématique et une méta-analyse pour évaluer la capacité
de discrimination du modèle de prédiction du risque de mort subite d’origine cardiaque
(MSOC) lors de cardiomyopathie hypertrophique (CMH) de la Société européenne de cardiologie
(SEC).
Méthodes
Nous avons effectué des recherches dans les bases de données PubMed, Embase et Web
of Science, CNKI, WanFang et China Biology Medicine disc (CBMdisc) pour trouver des
articles anglais et chinois qui portaient sur la validation du modèle de risque. Nous
avons calculé la capacité de discrimination du modèle à des seuils critiques de 4
% et de 6 % selon les données extraites. La statistique C extraite et la surface sous
la courbe (SSC) calculée avec des intervalles de confiance (IC) à 95 % de toutes les
études ont été pondérées et résumées. Nous avons quantifié l’hétérogénéité à l’aide
des statistiques I2 et nous avons évalué l’analyse de sensibilité et les biais de publication à l’aide
du test d’Egger.
Résultats
Nous avons choisi 13 études qui portaient sur la validation de l’utilité du modèle.
Nous avons conclu que le modèle a une excellente spécificité, bien qu’il ait une sensibilité
médiocre lorsque l’on fixe la valeur limite recommandée de 6 % pour déterminer les
patients exposés à un risque élevé de CMH. De plus, la valeur de discrimination était
modérée (statistique C globale = 0,75, IC à 95 %, 0,67-0,83; seuil critique ≥ 4 %;
SSC = 0,69, IC à 95 %, 0,62-0,75; seuil critique ≥ 6 %; SSC = 0,65, IC à 95 %, 0,59-0,72).
L’analyse en sous-groupes de régions a montré une capacité prédictive légèrement plus
faible pour l’Amérique du Nord. Il n’y a eu aucun biais de publication (tous P > 0,05); l’analyse de sensibilité n’a pas significativement changé les résultats.
Conclusions
Le modèle de prédiction du risque de MSOC lors de CMH de la SEC a une excellente spécificité
et une sensibilité médiocre, ainsi qu’une capacité de discrimination modérée. La valeur
de prédiction peut en outre être plus faible pour l’Amérique du Nord que pour les
autres régions.
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Article info
Publication history
Published online: May 10, 2019
Accepted:
May 5,
2019
Received:
December 31,
2018
Footnotes
See editorial by Maron et al., pages 1626--1628 of this issue.
See page 1798 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- The ESC Risk Score Is Less Reliable than ACC/AHA Risk Factors in Hypertrophic Cardiomyopathy: When Sensitivity Trumps SpecificityCanadian Journal of CardiologyVol. 35Issue 12
- PreviewSudden cardiac death (SCD) remains the most visible and devastating consequence of hypertrophic cardiomyopathy (HCM).1-3 The proven efficacy of the implantable cardioverter defibrillator (ICD) in aborting lethal ventricular tachyarrhythmias, changing clinical course, and saving young lives in patients with HCM has placed increasing weight on the importance of accurate selection of patients for device therapy.3-9 Beginning in 2003, and most recently in 2017, North American expert consensus guidelines have recommended a strategy in which decisions for primary prevention ICDs are based on the presence of 1 or more risk markers regarded as major within the clinical profile of a patient with HCM.
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