Efthimiadis Georgios K, Parcharidou Despina G, Giannakoulas Georgios, Pagourelias Efstathios D, Charalampidis Panagiotis, Savvopoulos Gregorios, Ziakas Antonios, Karvounis Haralambos, Styliadis Ioannis H, Parcharidis Georgios E
First Cardiology Department, Cardiomyopathies Laboratory, Aristotle University of Thessaloniki Medical School, AHEPA Hospital, Thessaloniki, Greece.
Am J Cardiol. 2009 Sep 1;104(5):695-9. doi: 10.1016/j.amjcard.2009.04.039. Epub 2009 Jun 24.
The effect of left ventricular outflow tract obstruction (LVOTO) at rest on the incidence of sudden death (SD) in patients with hypertrophic cardiomyopathy is rather conflicting. The aim of this study was the evaluation of LVOTO at rest as a new potential risk factor for SD in hypertrophic cardiomyopathy. A total of 166 patients (112 men, 51.8 +/- 15.6 years) were studied; 50 patients (30.1%) had peak instantaneous LVOTO gradients of > or = 30 mm Hg at rest. During the follow-up period (median 32.4 months, range 1 to 209), 13 patients either died suddenly, or had cardiac arrest, documented sustained ventricular tachycardia, or implantable cardioverter defibrillator discharge. The cumulative event-free survival rate was 92% in patients with LVOTO, and 92% in patients without obstruction (p = NS). LVOTO at rest was associated with a particularly low positive predictive value for SD (8%), although a high negative predictive value (92%) was recorded. Patients having syncope or presenting with a maximum wall thickness > or =3 cm in echocardiography were more sensitive to SD emergence because they had a 13.07 (95% confidence interval 4.00 to 46.95, p <0.0001) and a 10.07 (95% confidence interval 2.92 to 34.79, p = 0.003) greater relative risk, respectively. In conclusion, our cohort study results do not support LVOTO as an independent risk factor for SD in patients with hypertrophic cardiomyopathy.
肥厚型心肌病患者静息时左心室流出道梗阻（LVOTO）对猝死（SD）发生率的影响存在相当大的争议。本研究的目的是评估静息时的LVOTO作为肥厚型心肌病患者SD的一个新的潜在危险因素。共研究了166例患者（112例男性，年龄51.8±15.6岁）；50例患者（30.1%）静息时左心室流出道峰值瞬时梯度≥30 mmHg。在随访期间（中位时间32.4个月，范围1至209个月），13例患者发生猝死、心脏骤停、记录到持续性室性心动过速或植入式心脏复律除颤器放电。LVOTO患者的累积无事件生存率为92%，无梗阻患者为92%（p=无显著性差异）。静息时的LVOTO对SD的阳性预测值特别低（8%），尽管记录到较高的阴性预测值（92%）。有晕厥或超声心动图显示最大壁厚≥3 cm的患者对SD的发生更敏感，因为他们的相对风险分别高13.07（95%置信区间4.00至46.95，p<0.0001）和10.07（95%置信区间2.92至34.79，p=0.003）。总之，我们的队列研究结果不支持LVOTO作为肥厚型心肌病患者SD的独立危险因素。
