McLeod Christopher J, Ackerman Michael J, Nishimura Rick A, Tajik A Jamil, Gersh Bernard J, Ommen Steve R
Department of Internal Medicine/Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Am Coll Cardiol. 2009 Jul 14;54(3):229-33. doi: 10.1016/j.jacc.2009.02.071.
This study sought to clarify the frequency, clinical phenotype, and prognosis of those patients with hypertrophic cardiomyopathy (HCM) who present with a normal electrocardiogram (ECG).
Hypertrophic cardiomyopathy is the most common cause of sudden death in young people. Screening advocates have recommended a 12-lead ECG for the early detection of HCM in athletes, yet the clinical outcomes of those presenting with a normal ECG remains to be fully delineated.
Baseline characteristic and echocardiographic data were collected on all patients with HCM who initially presented to our institution with a diagnostic echocardiogram but a normal ECG. Follow-up was obtained and compared with the prognosis of HCM patients who presented with abnormal ECGs.
We compared 135 HCM patients with a normal ECG with 2,350 HCM patients with an abnormal ECG. The latter group was more likely to have worse symptoms, have higher gradients, and a greater degree of septal wall thickness than the patients with a normal ECG. Severe obstructive symptoms requiring surgical myectomy and implantation of an implantable cardioverter-defibrillator were more common in patients with abnormal ECGs. Cardiac survival was significantly better in the group with a normal ECG at presentation-none of these patients had a cardiac death at follow-up.
Almost 6% of patients presenting with demonstrable echocardiographic evidence of HCM had a normal ECG at the time of diagnosis. This subset of patients with normal ECG-HCM appears to exhibit a less severe phenotype with better cardiovascular outcomes.
本研究旨在阐明心电图（ECG）正常的肥厚型心肌病（HCM）患者的发病频率、临床表型及预后。
肥厚型心肌病是年轻人猝死的最常见原因。筛查倡导者建议对运动员进行12导联心电图检查以早期发现肥厚型心肌病，但心电图正常者的临床结局仍有待全面描述。
收集所有最初因诊断性超声心动图而心电图正常前来我院就诊的肥厚型心肌病患者的基线特征和超声心动图数据。进行随访并与心电图异常的肥厚型心肌病患者的预后进行比较。
我们将135例心电图正常的肥厚型心肌病患者与2350例心电图异常的肥厚型心肌病患者进行了比较。后一组患者比心电图正常的患者更有可能出现更严重的症状、更高的压力阶差和更大程度的室间隔增厚。需要手术切除心肌和植入植入式心脏复律除颤器的严重梗阻症状在心电图异常的患者中更为常见。初次就诊时心电图正常的患者心脏生存率显著更高，这些患者在随访中均无心脏死亡。
几乎6%经超声心动图证实有肥厚型心肌病证据的患者在诊断时心电图正常。这一心电图正常的肥厚型心肌病患者亚组似乎表现出较轻的表型，心血管结局更好。
