Fatores de risco presentes na cardiomiopatia hipertrófica que podem ocasionar morte súbita: uma revisão sistemática

Abstract

Introduction: Cardiovascular diseases have always been present at the top of the causes of sudden death worldwide, however, although hypertrophic cardiomyopathy (HCM) is currently configured as the main cause of sudden death in young people worldwide, the main factors risk in young adulthood are not yet consolidated in the literature. Therefore, this study aimed to identify the risk factors for sudden death present in adult individuals with hypertrophic cardiomyopathy, through a systematic review of the literature. Methods: The search strategy was performed in the MEDLINE/PubMed and Web of Science databases from January to July 2022, with studies published from 2000 to 2021. The following terms were used individually in the interface of each database: sudden death, sudden cardiac death, hypertrophic cardiomyopathy, risk stratification, clinical outcome and prevention of sudden death. In order to combine the terms, Boolean operators -OR and -AND were used. After applying the eligibility criteria, the studies were submitted to the evaluation of the methodological quality proposed by the National Institutes of Health (NIH), of the Department of Health and Human Resources of the United States, according to the epidemiological design of the study. Results: Through the search strategy, 7404 titles were found, and of these, at the end of the selection process, seven articles were included in the review. Among the included studies, it was observed that all six predictors studied – family history of sudden death, previous history of unexplained syncope, maximum left ventricular thickness above 30 mm, non-sustained ventricular tachycardia, abnormal blood pressure response to physical exercise, and obstruction left ventricular outflow tract above 30 mmHg – are associated with a higher risk of sudden death in patients with hypertrophic cardiomyopathy, and are therefore validated as risk factors. The combination of two factors only had a greater impact when family history predictors of sudden death and syncope were used. Conclusion: It is noted the influence that all factors evaluated have a predisposition to sudden death. The highest magnitude factor identified was a family history of sudden death. Based on the findings of this review, it is hypothesized that family episodes significantly influence the occurrence of the outcome due to the genetic etiology of the disease.