Trans-Atlantic Differences in Approach to Sudden Death Prevention in Hypertrophic Cardiomyopathy.

The American approach to predicting sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM) diverges from the European method in that it relies on major risk factors independently justifying the implantation of an (implantable cardioverter-defibrillator) ICD for primary prevention, whereas the European approach utilizes a mathematical equation to estimate a 5-year risk percentage. The aim of this review is to outline the differences between the American and European guidelines and to demonstrate how they have arisen. Furthermore, it will provide insight into the future of SCD risk prediction in HCM. The American SCD risk prediction method demonstrates high sensitivity but limited specificity, whereas the European method exhibits the opposite. These differences in sensitivity and specificity likely contribute to the fact that primary prevention ICD utilization is two-fold higher in the U.S. It is highly likely that new insights and new imaging modalities will enhance prediction models in the near future. Genotyping could potentially assume a significant role. Left ventricular global longitudinal strain was recently found to be an independent predictor of SCD. Furthermore, following late gadolinium enhancement, additional cardiac magnetic resonance techniques such as T1 mapping and diffusion tensor imaging are demonstrating encouraging outcomes in predicting SCD. Ultimately, it is conceivable that integrating diverse morphological and genetic characteristics through deep learning will yield novel insights and enhance SCD prediction methods.