Abstract
Background
Recently, a new risk model was developed, namely hypertrophic cardiomyopathy (HCM)
risk for cerebrovascular accident, for estimating the risk of thromboembolism (TE)
in patients with HCM. There is no study about the external validation of this model.
Methods
We evaluated the performance of the model for predicting TE in 417 patients with HCM
recruited between 2008 and 2016, from a tertiary referral centre. The primary end
point was 5-year TE, and the risk was calculated using the model formula.
Results
During a median follow-up of 3.5 years, 25 (6.0%) patients reached the TE end point,
and 22 (5.3%) patients within the first 5 years. Within a 5-year time frame, the model
showed a possibly helpful discrimination for TE (C-index for the whole cohort: 0.67,
C-index for the subgroup without atrial fibrillation: 0.67) relative to its original
C-index of 0.75. However, the calibration was not perfect, which suggested that there
was an underestimation of 5-year TE risk in the whole cohort and different risk groups.
Conclusions
HCM risk for cerebrovascular accident demonstrated a possibly helpful discrimination
for TE when applied in a new set of patients with HCM. However, the accurate estimation
of absolute risk should be explored in future studies.
Résumé
Contexte
Récemment, un nouveau modèle de risque a été mis au point, soit le modèle de risque
d’accident vasculaire cérébral associé à la cardiomyopathie hypertrophique, afin d’évaluer
le risque de thromboembolie chez les patients atteints de cardiomyopathie hypertrophique.
Aucune étude de validation indépendante n’a été menée sur ce modèle.
Méthodologie
Nous avons évalué l’efficacité de ce modèle pour prédire la survenue d’une thromboembolie
chez 417 patients atteints de cardiomyopathie hypertrophique, recrutés entre 2008
et 2016 dans un centre de référence tertiaire. Le critère d’évaluation principal était
la survenue de la thromboembolie dans les 5 ans, le risque ayant été calculé à l’aide
de la formule du modèle.
Résultats
Pendant un suivi médian de 3,5 ans, 25 patients (6,0 %) ont atteint le critère d’évaluation,
soit la thromboembolie, et 22 patients (5,3 %) l’ont fait au cours des 5 premières
années. En l’espace de 5 ans, le modèle a montré une discrimination qui pourrait être
utile pour prédire la survenue d’une thromboembolie (indice de concordance de 0,67
pour l’ensemble de la cohorte ainsi que pour le sous-groupe ne souffrant pas de fibrillation
auriculaire, par rapport à l’indice de concordance initial de 0,75). Toutefois, la
calibration était imparfaite, laissant supposer une sous-estimation du risque de thromboembolie
sur 5 ans dans l’ensemble de la cohorte et les différents groupes de risque.
Conclusions
Le modèle de risque d’accident vasculaire cérébral associé à la cardiomyopathie hypertrophique
a montré une discrimination qui pourrait être utile au regard de la thromboembolie
lorsqu’il est appliqué à un nouveau groupe de patients atteints de cardiomyopathie
hypertrophique. Toutefois, il faudrait mener d’autres études pour évaluer avec précision
le risque absolu.
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References
- 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC).Eur Heart J. 2014; 35: 2733-2779
- Clinical profile of stroke in 900 patients with hypertrophic cardiomyopathy.J Am Coll Cardiol. 2002; 39: 301-307
- 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation—developed with the special contribution of the European Heart Rhythm Association.Europace. 2012; 14: 1385-1413
- Prediction of thrombo-embolic risk in patients with hypertrophic cardiomyopathy (HCM Risk-CVA).Eur J Heart Fail. 2015; 17: 837-845
- Stroke and embolic events in hypertrophic cardiomyopathy: risk stratification in patients without atrial fibrillation.Stroke. 2016; 47: 936-942
- Temporal trends of the prevalence and incidence of atrial fibrillation and stroke among Asian patients with hypertrophic cardiomyopathy: a nationwide population-based study.Int J Cardiol. 2018; 273: 130-135
- Atrial fibrillation and thromboembolism in hypertrophic cardiomyopathy—an underestimated risk.Int J Cardiol. 2018; 273: 187-188
- Prognosis and prognostic research: validating a prognostic model.BMJ. 2009; 338: b605
- Risk prediction models: II. External validation, model updating, and impact assessment.Heart. 2012; 98: 691-698
- Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation.Chest. 2010; 137: 263-272
- Discrimination and calibration of clinical prediction models: users’ guides to the medical literature.JAMA. 2017; 318: 1377-1384
- A calibration hierarchy for risk models was defined: from utopia to empirical data.J Clin Epidemiol. 2016; 74: 167-176
- Cerebrovascular complications associated with idiopathic hypertrophic subaortic stenosis.Stroke. 1984; 15: 282-284
- Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy: systematic review.Heart. 2014; 100: 465-472
- Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy.Circulation. 2001; 104: 2517-2524
- Heart failure prognostic models: why bother?.Circ Heart Fail. 2012; 5: 6-9
- Validity evaluation of recently published diabetes risk scoring models in a general Chinese population.Diabetes Res Clin Pract. 2012; 95: 291-298
- An Asian validation of the TIMI risk score for ST-segment elevation myocardial infarction.PLoS One. 2012; 7e40249
- 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Circulation. 2011; 124: e783-e831
- Atrial fibrillation and anticoagulation in hypertrophic cardiomyopathy.Arrhythm Electrophysiol Rev. 2017; 6: 63-68
- Stroke and bleeding risks in NOAC- and warfarin-treated patients with hypertrophic cardiomyopathy and atrial fibrillation.J Am Coll Cardiol. 2016; 67: 3020-3021
Article info
Publication history
Published online: May 30, 2019
Accepted:
May 23,
2019
Received:
April 19,
2019
Footnotes
See page 1805 for disclosure information.
See editorial by Veselka, pages 1629--1630 of this issue.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Hypertrophic Cardiomyopathy Is at Increased Risk of Thromboembolic Events: Deficiencies of CHA2DS2-VASC Score and How to PredictCanadian Journal of CardiologyVol. 35Issue 12
- PreviewPatients with hypertrophic cardiomyopathy (HCM) are at increased risk of potentially catastrophic thromboembolic (TE) events that can occur without any previous clinical symptoms.1,2 The most important therapeutic measure is lifelong anticoagulation therapy in all patients who have experienced a first episode of atrial fibrillation or TE event.3 Unlike the risk assessment strategies used for atrial fibrillation in the general population, the Congestive Heart Failure, Hypertension, Diabetes Mellitus, Vascular Disease, Age 65 to 74 Years, and Female Sex, and 2 Points Each For Age ≥ 75 Years And Prior Stroke, Transient Ischemic Attack, and Thromboembolism (CHA2DS2-VASC) score is not usable in the setting of HCM.
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