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NSVT in HCM Risk Assessment — EECC MCQ

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ModerateCardiomyopathyNSVT in HCM Risk AssessmentEECC

A 28-year-old man with HCM (MWT 22 mm, no obstruction) undergoes exercise testing with continuous ECG monitoring. During recovery, he develops a 10-beat run of non-sustained VT (NSVT) at 180 bpm. His HCM Risk-SCD 5-year score is 5.2%. How does NSVT affect his risk assessment?

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Correct answer: E — NSVT is one of the seven variables in the ESC HCM Risk-SCD calculator and independently contributes to the overall risk score; its presence already contributed to his intermediate 5.2% score — additional risk modifiers (LGE extent, apical aneurysm) should be assessed

NSVT (≥3 consecutive ventricular beats at ≥120 bpm lasting <30 seconds) is one of the seven clinical variables in the ESC HCM Risk-SCD calculator (alongside age, MWT, LA diameter, maximal LVOT gradient, family history of SCD, and unexplained syncope). NSVT on ambulatory monitoring is found in ~20-30% of HCM patients and is an independent marker of increased SCD risk. Its contribution to the overall risk score is modulated by the other variables. At a calculated 5-year risk of 5.2% (intermediate zone 4-6%), the ESC 2023 Cardiomyopathy Guidelines recommend considering additional risk modifiers NOT in the calculator: (1) extensive LGE (≥15% of LV mass); (2) LV apical aneurysm; (3) LVEF <50%; (4) exercise-induced BP drop. These may upgrade an intermediate-risk patient to ICD candidacy.

Reference: ESC (2023): Guidelines on Cardiomyopathies