Kimball T R, Daniels S R, Meyer R A, Schwartz D C, Kaplan S
Division of Cardiology, Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH 45229.
Am Heart J. 1991 Jul;122(1 Pt 1):126-31. doi: 10.1016/0002-8703(91)90769-e.
To determine the relationship of left ventricular hypertrophy (as assessed by mass) to symptoms and cardiac function in chronic childhood dilated cardiomyopathy, 17 long-term survivors (12 asymptomatic, 5 symptomatic) were studied at a median follow-up of 6.25 years (1.25 to 16.8 years). Left ventricular mass, dimension, wall stress, and contractility (relationship between velocity of circumferential fiber shortening and end-systolic wall stress) were assessed by echocardiography. These data were compared to measurements at the onset of disease. At follow-up, mass decreased significantly from the onset in the asymptomatic patients but remained elevated in the symptomatic patients (101 +/- 35 gm/m2 to 54 +/- 12 gm/m2, p = 0.001; 122 +/- 55 gm/m2 to 198 +/- 115 gm/m2, p = 0.23, respectively). Shortening fraction and contractility were both significantly lower in the symptomatic group compared with the asymptomatic group at follow-up (shortening fraction = 21 +/- 7% vs 29 +/- 5%, p = 0.02; contractility = -0.24 +/- 0.14 circ/sec vs -0.05 +/- 0.11 circ/sec, p = 0.01). Follow-up wall stress was slightly higher in symptomatic patients compared with asymptomatic patients. Three symptomatic patients had progressive hypertrophy and either died or required transplantation. Higher left ventricular mass is associated with the presence of symptoms, depressed contractility, and slightly higher wall stress. Persistence or progression of hypertrophy may be a poor prognostic sign in survivors of childhood dilated cardiomyopathy. Measurement of mass may be useful to indicate the necessity for closer follow-up to select patients for cardiac transplantation before hemodynamic decompensation.
为了确定慢性儿童扩张型心肌病中左心室肥厚（通过质量评估）与症状及心功能的关系，对17例长期存活者（12例无症状，5例有症状）进行了研究，中位随访时间为6.25年（1.25至16.8年）。通过超声心动图评估左心室质量、尺寸、壁应力和收缩性（圆周纤维缩短速度与收缩末期壁应力之间的关系）。将这些数据与疾病发作时的测量值进行比较。随访时，无症状患者的质量较发病时显著下降，但有症状患者的质量仍升高（分别从101±35 g/m²降至54±12 g/m²，p = 0.001；从122±55 g/m²升至198±115 g/m²，p = 0.23）。随访时，有症状组的缩短分数和收缩性均显著低于无症状组（缩短分数 = 21±7%对29±5%，p = 0.02；收缩性 = -0.24±0.14周/秒对-0.05±0.11周/秒，p = 0.01）。有症状患者的随访壁应力略高于无症状患者。3例有症状患者出现进行性肥厚，最终死亡或需要移植。较高的左心室质量与症状的出现、收缩性降低和壁应力略高有关。肥厚的持续或进展可能是儿童扩张型心肌病存活者预后不良的标志。测量质量可能有助于表明有必要进行更密切的随访，以便在血流动力学失代偿前选择心脏移植患者。
