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Canadian Journal of Cardiology

External Validation of the Model of Thromboembolic Risk in Hypertrophic Cardiomyopathy Patients

  • Author Footnotes
    ‡ These authors contributed equally to this work.
    Sen He
    Footnotes
    ‡ These authors contributed equally to this work.
    Affiliations
    Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China

    Department of Cardiology, National University Heart Centre, Singapore
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  • Author Footnotes
    ‡ These authors contributed equally to this work.
    Ziqiong Wang
    Footnotes
    ‡ These authors contributed equally to this work.
    Affiliations
    Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China

    Department of Cardiology, National University Heart Centre, Singapore
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  • Tan Huay Cheem
    Affiliations
    Department of Cardiology, National University Heart Centre, Singapore
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  • Hang Liao
    Affiliations
    Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
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  • Xiaoping Chen
    Correspondence
    Corresponding author: Dr Xiaoping Chen and Dr Yong He, Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China. Tel.: +86-028-85422343; fax: +86-028-85422175.
    Affiliations
    Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
    Search for articles by this author
  • Yong He
    Correspondence
    Corresponding author: Dr Xiaoping Chen and Dr Yong He, Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China. Tel.: +86-028-85422343; fax: +86-028-85422175.
    Affiliations
    Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
    Search for articles by this author
  • Author Footnotes
    ‡ These authors contributed equally to this work.

      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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      Linked Article

      • Hypertrophic Cardiomyopathy Is at Increased Risk of Thromboembolic Events: Deficiencies of CHA2DS2-VASC Score and How to Predict
        Canadian Journal of CardiologyVol. 35Issue 12
        • Preview
          Patients 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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