Zeng Zhiyu, Wang Fangzheng, Dou Xiangfeng, Zhang Shu, Pu Jielin
Center for Arrhythmia Diagnosis and Treatment, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Int J Cardiol. 2006 Sep 10;112(1):80-4. doi: 10.1016/j.ijcard.2005.10.009. Epub 2006 Feb 28.
The effects of percutaneous transluminal septal myocardial ablation (PTSMA) with septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM) are not thoroughly compared.
Three articles comparing the effects of PTSMA and septal myectomy treatment for HOCM were identified from a search in Pubmed, and a meta analysis was conducted.
177 patients (86 underwent PTSMA and 91 underwent septal myectomy) were included. Interventricular septum thickness was decreased from 22.1 to 15.1 mm (p<0.05) in PTSMA group and from 22.0 to 13.9 mm (p<0.05) in septal myectomy group; left ventricular end-diastolic dimension was increased from 41.8 to 45.2 mm (p<0.05) in PTSMA group and from 41.8 to 43.9 mm (p<0.05) in septal myectomy group; NYHA class was improved from 3.17 to 1.47 (p<0.05) in PTSMA group and from 2.97 to 1.36 (p<0.05) in septal myectomy group; there were no differences in the two groups. However, left ventricular outflow tract gradient was decreased from 76.0 to 15.7 mm Hg (p<0.05) in PTSMA group and from 74.7 to 9.4 mm Hg (p<0.05) in septal myectomy group and the effect of septal myectomy was better than PTSMA (p<0.05).
The effects of septal myectomy treatment for HOCM are better with regard to relief of LVOT gradient, and lower risk of pacemaker requirement, compared to PTSMA. Large randomized clinical trials further comparing the two treatments are suggested.
肥厚性梗阻性心肌病（HOCM）患者经皮腔内室间隔心肌消融术（PTSMA）与室间隔心肌切除术的疗效尚未得到充分比较。
通过检索PubMed确定了3篇比较PTSMA和室间隔心肌切除术治疗HOCM疗效的文章，并进行了荟萃分析。
共纳入177例患者（86例行PTSMA，91例行室间隔心肌切除术）。PTSMA组室间隔厚度从22.1 mm降至15.1 mm（p<0.05），室间隔心肌切除术组从22.0 mm降至13.9 mm（p<0.05）；PTSMA组左心室舒张末期内径从41.8 mm增加至45.2 mm（p<0.05），室间隔心肌切除术组从41.8 mm增加至43.9 mm（p<0.05）；PTSMA组纽约心脏协会（NYHA）心功能分级从3.17改善至1.47（p<0.05），室间隔心肌切除术组从2.97改善至1.36（p<0.05）；两组间无差异。然而，PTSMA组左心室流出道压差从76.0 mmHg降至15.7 mmHg（p<0.05），室间隔心肌切除术组从74.7 mmHg降至9.4 mmHg（p<0.05），室间隔心肌切除术的效果优于PTSMA（p<0.05）。
与PTSMA相比，室间隔心肌切除术治疗HOCM在缓解左心室流出道压差方面效果更好，起搏器植入需求风险更低。建议开展进一步比较这两种治疗方法的大型随机临床试验。
