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Canadian Journal of Cardiology

Variable and Limited Predictive Value of the European Society of Cardiology Hypertrophic Cardiomyopathy Sudden-Death Risk Model: A Meta-analysis

      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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      Linked Article

      • The ESC Risk Score Is Less Reliable than ACC/AHA Risk Factors in Hypertrophic Cardiomyopathy: When Sensitivity Trumps Specificity
        Canadian Journal of CardiologyVol. 35Issue 12
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          Sudden 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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