Prediction of sudden death in obstructive hypertrophic cardiomyopathy after septal myectomy: Targeting the candidate.

Abstract

To evaluate the applicability of current guidelines for patients with postoperative hypertrophic cardiomyopathy and identify key risk factors for sudden cardiac death (SCD). We retrospectively analyzed 1915 adult patients who underwent septal myectomy from 2010 to 2019. Competing risk models assessed the effectiveness of the updated 2024 American Heart Association (AHA)/American College of Cardiology and 2023 European Society of Cardiology (ESC) guidelines in guiding implantable cardioverter defibrillator (ICD) recommendations for preventing SCD after surgery. Over a follow-up period of 4.6 ± 2.7 years, 19 SCD events and 1 ICD discharge were observed. No significant differences were found in AHA (Class 2a: 55% vs 39.3%; Class 2b: 5% vs 5.4%; Class 3: 40% vs 55.3%, P = .354) or ESC (Class 2a: 45% vs 45.3%; Class 2b: 20% vs 22.8%; Class 3: 35% vs 31.9%, P = .937) ICD recommendations, prevalence of major SCD risk factors, or 5-year SCD risk between event and nonevent groups. Survival analysis showed that ESC and AHA stratification did not significantly predict SCD (both P > .05). Left ventricular wall thickness (LVWT) (P = .028) and late gadolinium enhancement (LGE) (P = .015) were significant predictors. Cardiac index showed a potential association with SCD (nonlinear trend, P = .012; overall, P = .027). Patients with LVWT ≥30 mm and LGE ≥15% had a greater risk of SCD (subdistribution hazard ratio, 5.60; 95% confidence interval, 1.90-16.5, P = .002). Current guidelines are inadequate for assessing postoperative SCD risk in patients with hypertrophic cardiomyopathy. LGE and LVWT are reliable indicators, highlighting the need for novel approaches to guide ICD implantation.