Miller Marc A, Gomes J Anthony, Fuster Valentin
Mount Sinai School of Medicine, New York, NY 10029, USA.
Nat Clin Pract Cardiovasc Med. 2007 Dec;4(12):667-76. doi: 10.1038/ncpcardio1057.
Hypertrophic cardiomyopathy (HCM) is the most common hereditary cardiac condition and the leading cause of sudden cardiac death (SCD) in young adults. Given that SCD can be the first and most devastating clinical expression of HCM, identifying individuals at high risk is paramount. Determining an individual's risk for HCM-related SCD requires a thorough understanding of the recognized risk factors, of which there are seven established or 'major' and five 'possible'. Major risk factors can be identified by thoroughly reviewing a patient's personal medical history and noninvasive cardiovascular testing. The presence of major risk factors identify patients who are at high enough risk of SCD to warrant consideration of an implantable cardioverter-defibrillator; whereas the absence of any major risk factors provides considerable reassurance to both patient and physician. The risk of HCM-related SCD in patients with no major risk factors is, however, not zero. Possible risk factors gain importance in the presence of an isolated major risk factor. Here, we provide a contemporary review of established and possible risk factors for HCM-related SCD. We also examine microvolt T-wave alternans and cardiovascular MRI as emerging risk stratification tools that could further hone our ability to accurately identify the high-risk patient.
肥厚型心肌病（HCM）是最常见的遗传性心脏疾病，也是年轻成年人心脏性猝死（SCD）的主要原因。鉴于SCD可能是HCM的首发且最具毁灭性的临床表现，识别高危个体至关重要。确定个体发生HCM相关SCD的风险需要全面了解已公认的风险因素，其中有七个已确定的或“主要”风险因素以及五个“可能”风险因素。通过全面回顾患者的个人病史和无创心血管检查可以识别主要风险因素。主要风险因素的存在可确定SCD风险足够高、值得考虑植入式心脏复律除颤器的患者；而不存在任何主要风险因素则可让患者和医生都相当安心。然而，没有主要风险因素的患者发生HCM相关SCD的风险并非为零。在存在单一主要风险因素的情况下，可能风险因素就变得重要起来。在此，我们对已确定的和可能的HCM相关SCD风险因素进行当代综述。我们还探讨了微伏级T波交替和心血管磁共振成像作为新兴的风险分层工具，它们可能进一步提高我们准确识别高危患者的能力。
