Department of Cardiology and Angiology, Marienhospital Herne, University of Bochum, Bochum, Germany.
Am J Cardiol. 2010 Jan 1;105(1):116-21. doi: 10.1016/j.amjcard.2009.08.662. Epub 2009 Nov 18.
Although the biventricular nature of the disease has been confirmed by morphologic studies, information on right ventricular (RV) function in hypertrophic cardiomyopathy (HC) is lacking. The aim of the study was to hemodynamically characterize RV performance in HC versus idiopathic dilated cardiomyopathy (IDC) during exercise. The hemodynamic data of 63 patients with HC who underwent hemodynamic exercise testing with thermodilution-derived assessment of RV ejection fraction were analyzed. The results were compared to a healthy control group (n = 20) and to patients with IDC (n = 86). The baseline RV ejection fraction was increased in the patients with HC compared to those with IDC (39 +/- 10% vs 33 +/- 12%; p = 0.002), but did not differ compared to controls (42 +/- 7% vs 39 +/- 10%; p = NS). An increase in end-diastolic volume from rest to exercise contributed to stroke volume augmentation in those with HC (121 +/- 38 vs 136 +/- 55 ml/m(2); p = 0.01) and control subjects (116 +/- 34 vs 138 +/- 31 ml/m(2); p = 0.002) but not in those with IDC (117 +/- 47 vs 120 +/- 52 ml/m(2); p = NS). At peak exercise the RV ejection fraction in those with HC was reduced compared to that in the controls (45 +/- 11% vs 59% +/- 9%; p <0.001), but it was increased compared to that in those with IDC (45 +/- 11% vs 35% +/- 11%; p <0.001). In conclusion, the extent of the pulmonary pressure increase was more pronounced in those with HC than in those with IDC, but the degree of functional impairment of the right ventricle was less severe, probably owing to its ability to recruit preload and contractile reserve with exercise.
尽管形态学研究已经证实该病为双心室性，但肥厚型心肌病（HC）患者右心室（RV）功能的相关信息仍缺乏。本研究旨在血流动力学方面比较 HC 与特发性扩张型心肌病（IDC）患者 RV 功能在运动中的差异。对 63 例行热稀释法 RV 射血分数评估的血流动力学运动试验的 HC 患者的血流动力学数据进行了分析。研究结果与健康对照组（n = 20）和 IDC 患者（n = 86）进行了比较。与 IDC 患者相比，HC 患者的基础 RV 射血分数升高（39 ± 10% vs 33 ± 12%；p = 0.002），但与对照组相比差异无统计学意义（42 ± 7% vs 39 ± 10%；p = NS）。HC 患者从静息到运动时的舒张末期容积增加有助于增加每搏量（121 ± 38 比 136 ± 55 ml/m2；p = 0.01）和对照组（116 ± 34 比 138 ± 31 ml/m2；p = 0.002），但 IDC 患者无此变化（117 ± 47 比 120 ± 52 ml/m2；p = NS）。HC 患者在运动峰值时的 RV 射血分数较对照组低（45 ± 11% vs 59% ± 9%；p <0.001），但较 IDC 患者高（45 ± 11% vs 35% ± 11%；p <0.001）。结论，HC 患者的肺动脉压升高程度比 IDC 患者更明显，但右心室功能损害程度较轻，可能是由于其在运动时能够增加前负荷和收缩储备的能力所致。
