Risk stratification for sudden death in hypertrophic cardiomyopathy
10.3760/cma.j.issn.0253-3758.2009.04.002
- VernacularTitle:肥厚型心肌病猝死危险因素分层
- Author:
Spirito PAOLO
1
;
Maron J BARRY
Author Information
1. Genoa 16128,Divisione di Cardlologia,Ente Ospedaliero Ospodali Galliera
- From:
Chinese Journal of Cardiology
2009;37(4):294-297
- CountryChina
- Language:Chinese
-
Abstract:
The natural history of hypertrophic cardiomyopathy(HCM)is extremely heterogeneous.Many patients remain asymptomatic throughout life,some develop severe symptoms of heart failure,but others die suddenly.often in the absence of previous symptoms and at a young age.Therefore,identification of those patients at high risk of sudden death represents a major clinical problem and has become an even greater challenge since the implantable cardioverter-defibrillator(ICD)has proved to be highly effective in preventing sudden death in HCM.Patients who have survived a cardiac arrest,or one or more episodes of sustained ventricular tachycardia,are considered to be at high risk and are candidates for an ICD.However,this patient subset represents a small proportion of the HCM population.The greatest difficulty concerns the identification of high risk patients who are candidates for primary prevention of sudden death with a prophylactic ICD.Decisions are based on generally accepted clinical markers which are associated with increased risk,including:family history of sudden death,extreme left ventricular(LV)wall thickness(≥30 mm),nonsustained ventricular tachycardia on Holter monitoring,unexplained(non-neurocardiogenic)syncope particularly in young patients,and hypotensive blood pressure response to exercise.Patients with end-stage HCM or a LV apical aneurysm represent important arrhythmogenic subsets also associated with substantially increased risk.Multiple or single strong risk markers are associated with increased sudden death risk and iustify consideration for a prophylactic ICD.
