Ruzyłło W, Chojnowska L, Demkow M, Witkowski A, Kuśmierczyk-Droszcz B, Piotrowski W, Rausinska L, Karcz M, Małecka L, Rydlewska-Sadowska W
National Institute of Cardiology, Warsaw, Poland.
Eur Heart J. 2000 May;21(9):770-7. doi: 10.1053/euhj.1999.1905.
This study was undertaken to evaluate mid-term clinical results of non-surgical myocardial reduction in patients with hypertrophic obstructive cardiomyopathy.
Twenty-five patients with left ventricular outflow tract obstruction (mean gradient of 84. 54+/-31.38 mmHg) and symptoms of dyspnoea, angina and/or syncope were treated with non-surgical myocardial reduction. The patients were followed-up for a mean period of 10.44+/-1.8 months. In all patients clinical examination with echocardiography was repeated after every 3 months of follow-up, and a symptom-limited treadmill test was repeated at the 6 month follow-up. Eighteen patients underwent simultaneous respiratory gas analysis.
Clinical follow-up examinations were achieved in all 25 patients. Persistent left ventricular outflow tract gradient reduction was seen in 23 patients. Seventeen patients had a reduction of left ventricular outflow tract gradient >50% of baseline value. Twenty patients showed a clinical improvement from 2.8+/-0.5 up to 1.2+/-0.5 NYHA class (P<0.001). The clinical improvement was matched by an improvement in objective measures of exercise capacity in patients with significant left ventricular outflow tract gradient reduction. Exercise time increased from 571.9+/-192.2 to 703.5+/-175.4 s, P<0. 001, and peak VO(2)increased from 14.6+/-5.2 to 20.5+/-8.6 ml. kg(-1)min(-1), P<0.05.
Significant left ventricular outflow tract gradient reduction with exercise capacity improvement was achieved in the majority of patients treated with non-surgical myocardial reduction. We recommend this method as an alternative to surgery for symptomatic patients with hypertrophic obstructive cardiomyopathy.
本研究旨在评估肥厚性梗阻性心肌病患者非手术心肌减容的中期临床结果。
25例左心室流出道梗阻（平均压差为84.54±31.38 mmHg）且有呼吸困难、心绞痛和/或晕厥症状的患者接受了非手术心肌减容治疗。患者平均随访10.44±1.8个月。所有患者在随访的每3个月后重复进行临床检查及超声心动图检查，并在随访6个月时重复进行症状限制性平板运动试验。18例患者同时进行了呼吸气体分析。
25例患者均完成了临床随访检查。23例患者左心室流出道压差持续降低。17例患者左心室流出道压差降低超过基线值的50%。20例患者的纽约心脏协会（NYHA）心功能分级从2.8±0.5级改善至1.2±0.5级（P<0.001）。对于左心室流出道压差显著降低的患者，临床改善与运动能力客观指标的改善相匹配。运动时间从571.9±192.2秒增加至703.5±175.4秒，P<0.001；峰值摄氧量从14.6±5.2 ml·kg⁻¹·min⁻¹增加至20.5±8.6 ml·kg⁻¹·min⁻¹，P<0.05。
大多数接受非手术心肌减容治疗的患者实现了左心室流出道压差的显著降低且运动能力得到改善。我们推荐该方法作为有症状的肥厚性梗阻性心肌病患者手术治疗的替代方案。
