Table 1

Comparison of AHA/ACC versus ESC strategies for sudden death prevention in HCM

VariablesAHA/ACC21 ESC20
ICD decisions≥1 risk markersQuantitative score
SDM in ICD decisionsRecommendedObjective score
Tested prospectivelyyesno
Annual event rateNot usedOver 5 years
Prediction of SD events
 Sensitivity95%33%
 Specificity78%92%
Flexible algorithm+Fixed
Number of ICDs needed to treat6.67.2
Risk markers used
 Syncope++
 Massive LVH++
 NSVT++
 Family history: HCM-SD++
 LGE (fibrosis)+0
 LV apical aneurysm+0
 End stage (EF <50%)+0
 CMR-related markers+0
 Age*++
 LVOT obstruction 30 mm Hg0+
 LA diameter0+
  • +=present.

  • 0=absent.

  • *Age is not itself a major risk marker in the AHA/ACC method, but it is given important weight in the guidelines as a variable that can impact decisions regarding prophylactic ICD.

  • ACC, American College of Cardiology; AHA, American Heart Association; CMR, cardiovascular magnetic resonance; EF, ejection fraction; ESC, European Society of Cardiology; HCM, hypertrophic cardiomyopathy; ICD, implantable cardioverter-defibrillator; LA, left atrium; LGE, late gadolinium enhancement; LV, left ventricle; LVH, left ventricular hypertrophy; LVOT, left ventricular outflow tract; NSVT, nonsustained ventricular tachycardia; SD, sudden death; SDM, shared decision making.