Dimitrow P Petkow, Podolec P, Grodecki J, Płazak W, Dudek D, Pieniazek P, Bacior B, Legutko J, Olszowska M, Kostkiewicz M, Kawecka-Jaszcz K, Tracz W, Dubiel J S
Institute of Cardiology, Collegium Medicum Jagiellonian University, Kraków, Poland.
Int J Cardiol. 2004 Mar;94(1):31-4. doi: 10.1016/j.ijcard.2003.03.010.
The aim of the study was to compare the influence of dual-chamber pacing vs. nonsurgical septal reduction on hemodynamic and morphological parameters in patients with obstructive form of hypertrophic cardiomyopathy.
Nineteen patients with dual-chamber pacing (group I) and 9 patients who underwent nonsurgical septal reduction (group II) were studied at baseline and after a 6-month follow-up. The changes of left ventricular outflow tract gradient and posterior wall thickness (as an index of left ventricular hypertrophy regression) were compared.
The baseline left ventricular outflow tract gradient was comparable between group I and group II (77+/-25 vs. 82+/-25 mm Hg, p>0.05). At 6-month follow-up, the left ventricular outflow tract gradient was reduced to a similar level in both groups (28+/-19 vs. 25+/-12 mm Hg, p>0.05). At baseline, posterior wall hypertrophy was comparable between groups (12.9+/-1.7 vs. 13.6+/-2.2 mm, p>0.05). During follow-up, the posterior wall thickness was unchanged in the pacing group (12.9+/-1.7 vs. 12.6+/-1.6 mm, p>0.05), whereas nonsurgical septal reduction induced regression of left ventricular hypertrophy in myocardial region remote from the infarcted septal segment (13.6+/-2.2 vs. 10.5+/-2.3 mm, p<0.003).
Despite comparable reduction of instantaneous left ventricular outflow tract gradient, the nonsurgical septal reduction decreased posterior wall thickness, whereas pacing did not reduce left ventricular hypertrophy. Thus, regression of left ventricular hypertrophy that appeared solely after nonsurgical septal reduction may reflect the more permanent reduction of left ventricular pressure overload. Thus, not only hemodynamic but also morphological benefit from nonsurgical septal reduction seems to indicate the superiority of this method over dual-chamber pacing.
本研究旨在比较双腔起搏与非手术性室间隔减容术对梗阻性肥厚型心肌病患者血流动力学和形态学参数的影响。
对19例接受双腔起搏的患者（I组）和9例接受非手术性室间隔减容术的患者（II组）在基线期及6个月随访后进行研究。比较左心室流出道梯度和后壁厚度（作为左心室肥厚消退的指标）的变化。
I组和II组基线时左心室流出道梯度相当（77±25 vs. 82±25 mmHg，p>0.05）。在6个月随访时，两组左心室流出道梯度均降至相似水平（28±19 vs. 25±12 mmHg，p>0.05）。基线时，两组后壁肥厚程度相当（12.9±1.7 vs. 13.6±2.2 mm，p>0.05）。随访期间，起搏组后壁厚度无变化（12.9±1.7 vs. 12.6±1.6 mm，p>0.05），而非手术性室间隔减容术使梗死室间隔节段以外心肌区域的左心室肥厚消退（13.6±2.2 vs. 10.5±2.3 mm，p<0.003）。
尽管瞬时左心室流出道梯度降低程度相当，但非手术性室间隔减容术降低了后壁厚度，而起搏并未减轻左心室肥厚。因此，仅在非手术性室间隔减容术后出现的左心室肥厚消退可能反映了左心室压力超负荷的更持久减轻。因此，非手术性室间隔减容术不仅在血流动力学方面，而且在形态学方面的益处似乎表明该方法优于双腔起搏。
