Cardiology Division, Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea.
J Am Soc Echocardiogr. 2009 Dec;22(12):1338-43. doi: 10.1016/j.echo.2009.09.016. Epub 2009 Oct 30.
Despite the relatively benign course for the majority of patients with hypertrophic cardiomyopathy (HCM), this disease may cause sudden cardiac death and progressive heart failure (HF). The aim of this study was to investigate useful parameters for predicting adverse outcomes of HCM, including echocardiographic parameters, cardiac magnetic resonance (CMR), and clinical markers.
Eighty-one patients with nonapical HCM (51 men; mean age, 57 +/- 14 years) who underwent CMR and echocardiography were prospectively evaluated. Cardiovascular events were defined as hospitalization for worsening HF, stroke, or cardiovascular death.
During the mean follow-up period of 41 +/- 17 months, there were 17 cardiovascular events (5 deaths, 7 hospitalizations for worsening HF, and 5 strokes). Univariate analysis showed that older age, atrial fibrillation, elevated E/E' ratio, increased left atrial (LA) volume index, presence of mitral regurgitation grade > 2, New York Heart Association class III or IV, and late gadolinium enhancement >or= 6% were associated with cardiovascular events. In multivariate Cox regression analysis, increased LA volume index was found to be an independent predictor of cardiovascular events (for each 5 mL/m(2) increase, hazard ratio, 1.28; 95% confidence interval, 1.10-1.48; P < .01). Increased LA volume index was also revealed to be an independent predictor for cardiovascular events other than death (for each 5 mL/m(2) increase, hazard ratio, 1.44; 95% confidence interval, 1.12-1.83; P < .01).
LA volume index is independently associated with adverse outcomes in patients with HCM and provides additional prognostic information.
尽管大多数肥厚型心肌病（HCM）患者的病程相对良性，但该疾病可导致心源性猝死和进行性心力衰竭（HF）。本研究旨在探讨预测 HCM 不良结局的有用参数，包括超声心动图参数、心脏磁共振（CMR）和临床标志物。
前瞻性评估了 81 名非心尖肥厚型心肌病（HCM）患者（51 名男性；平均年龄 57 +/- 14 岁）的 CMR 和超声心动图检查结果。心血管事件定义为因 HF 恶化、卒中和心血管死亡而住院。
在平均 41 +/- 17 个月的随访期间，发生了 17 例心血管事件（5 例死亡，7 例因 HF 恶化住院，5 例卒）。单因素分析显示，年龄较大、房颤、E/E'比值升高、左心房（LA）容积指数增加、存在二尖瓣反流程度>2 级、纽约心脏协会（NYHA）心功能分级 III 或 IV 级以及钆增强>或=6%与心血管事件相关。多变量 Cox 回归分析显示，LA 容积指数增加是心血管事件的独立预测因素（每增加 5 mL/m²，风险比为 1.28；95%置信区间为 1.10-1.48；P <.01）。LA 容积指数增加也是除死亡以外的心血管事件的独立预测因素（每增加 5 mL/m²，风险比为 1.44；95%置信区间为 1.12-1.83；P <.01）。
LA 容积指数与 HCM 患者的不良结局独立相关，并提供了额外的预后信息。
