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《国际心血管病杂志》[ISSN:1006-6977/CN:61-1281/TN]

期数:

2023年03期

页码:

181-185

栏目:

临床研究

出版日期:

2023-05-30

文章信息/Info

Title:

Clinical characteristics and prognosis of different subtypes of hypertrophic cardiomyopathy complicated with coronary artery disease

作者:

甘振邦; 魏佳展; 严雪娇; 葛继勇

233030 蚌埠医学院研究生院（甘振邦，魏佳展，葛继勇）,213004 南京医科大学附属常州市第二人民医院心内科（严雪娇）

Author(s):

GAN Zhenbang; WEI Jiazhan; YAN Xuejiao; GE Jiyong

Graduate School of Bengbu Medical College, Bengbu 233030

关键词:

肥厚型心肌病; 冠状动脉粥样硬化性心脏病; 临床特点; 预后

Keywords:

Hypertrophic cardiomyopathy;  Coronary heart disease;  Clinical features; prognosis

分类号:

-

DOI:

10.3969/j.issn.1673-6583.2023.03.013

文献标识码:

-

摘要:

目的：探讨不同肥厚部位的肥厚型心肌病（HCM）对冠状动脉粥样硬化性心脏病（冠心病）临床特征以及预后的影响。方法：纳入2013年4月至2020年12月在常州市第二人民医院住院治疗的124例HCM患者，其中HCM合并冠心病组为62例，对照组（HCM未合并冠心病）62例。根据肥厚部位不同，将HCM合并冠心病患者分为心尖型组、室间隔型组、其他型组3组。长期随访的终点包括全因性死亡和不良心血管事件的发生。结果：在不同亚型HCM合并冠心病患者中，室间隔型组发生晕厥的数量多于心尖型组和对照组（P均＜0.05），室间隔型组入院时测量的收缩压高于对照组（P＜0.05）。超声心动图检测结果显示，室间隔型组的室间隔厚度最宽，对照组最窄，室间隔型组以及心尖型组左心房内径均高于对照组（P均＜0.05）。对病变血管的分析显示，对照组、室间隔型组、其他型组发生在左主干-前降支的比例高于心尖型组（P均＜0.05）。以狭窄程度＞75%作为血管狭窄的判定标准，心尖型组以及对照组无血管狭窄的患者比例高于室间隔型组（P均＜0.05），室间隔型组1支血管狭窄的患者比例高于对照组以及心尖型组（P均＜0.05）。室间隔型组行经皮冠状动脉介入术的比例高于对照组及心尖型组（P均＜0.05）。在随访过程中，室间隔型组的总体生存率较低（P＜0.05）。结论：在肥厚部位不同的HCM合并冠心病患者中，肥厚部位在室间隔的HCM对血管狭窄程度影响较重，在长期的预后中，室间隔型HCM合并冠心病患者的预后较差。

Abstract:

Objective: To investigate the impact of different sites of myocardial hypertrophy on clinical features and prognosis in patients with hypertrophic cardiomyopathy (HCM) and coronary artery disease (CAD). Methods: A total of 124 patients with HCM were recruited in Changzhou Second People’s Hospital from April 2013 to December 2020. Among them, 62 cases had combined CAD (HCM＋CAD group), and 62 cases had HCM only (control group). Patients in HCM＋CAD group were further stratified according to the site of myocardial hypertrophy (apical, ventricular septal, and other regional wall). All-cause mortality and adverse cardiovascular events during clinical follow-up were recorded.? Results: Number of syncope was higher in HCM＋CAD patients with ventricular septal hypertrophy than that in those with apical hypertrophy and in control group (all P＜0.05). Systolic blood pressure was more elevated in HCM＋CAD patients with ventricular septal hypertrophy compared with control group(P＜0.05). Echocardiographic examination revealed that HCM＋CAD patients with ventricular septal hypertrophy experienced largest ventricular septal thickness, whereas those in the control group had lowest septal thickness (P＜0.05). Compared with control group, left atrial diameter was greater in HCM＋CAD patients with ventricular septal or apical hypertrophy (all P＜0.05). The proportion of left main and left anterior descending artery disease was higher in control group and HCM＋CAD patients with ventricular septal or other regional wall hypertrophy than that in HCM＋CAD patients with apical hypertrophy (P＜0.05). The incidence of significant CAD (defined as ＞75% luminal diameter stenosis) was higher in HCM＋CAD patients with ventricular septal hypertrophy compared to those with apical hypertrophy and control patients (P＜0.05), resulting in a higher rate of percutaneous coronary intervention in HCM＋CAD patients with ventricular septal hypertrophy (P＜0.05).? Conclusion: HCM with ventricular septal hypertrophy may confer an increased risk of severe CAD and poor long-term prognosis.

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备注/Memo

备注/Memo:

通信作者：葛继勇， E-mail：jiyong_ge@163.com

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更新日期/Last Update: 2023-05-30