First Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece.
Am J Cardiol. 2010 May 15;105(10):1445-50. doi: 10.1016/j.amjcard.2009.12.066. Epub 2010 Mar 30.
The purpose of the present study was to evaluate the prevalence and prognosis of patients incidentally diagnosed with hypertrophic cardiomyopathy (HC). We studied 380 consecutive patients with HC (49.3 +/- 17.2 years; 65% men) for a median of 58 months (range 6 to 454). The patients were divided into 2 groups: those incidentally diagnosed from routine examination findings (precordial murmur and/or abnormal electrocardiographic findings) and those diagnosed either because of symptomatic status or by screening because of a family history of HC. Those patients who had been incidentally diagnosed constituted 29.2% of our study cohort. Although overall mortality did not differ between the 2 groups (p = 0.12), the patients diagnosed either because of symptoms or a family history tended to have at least a 4.5-fold greater risk of cardiovascular death (relative risk 4.5, 95% confidence interval 1.04 to 19.6, p = 0.04) and a 4.22 greater risk of sudden death (relative risk 4.22, 95% confidence interval 1.0 to 18.22, p = 0.04). Despite the greater sudden death mortality among the nonincidentally diagnosed patients, no statistically significant difference was found concerning the sudden death risk factor frequency (p = 0.96) between the 2 groups. In conclusion, the discrepancy between the low numbers of patients reported by published registries and the relatively high prevalence of the disease in the general population can be attributed to the large number of patients who remain asymptomatic, even throughout their life, awaiting an accidental diagnosis. Those patients with an incidental diagnosis have a more benign course, as shown by the total cardiovascular and composite sudden death mortality. A high level of awareness and suspicion for HC among physicians is essential for clinical recognition of such patients.
本研究的目的是评估偶然诊断为肥厚型心肌病（HC）患者的患病率和预后。我们研究了 380 例连续的 HC 患者（49.3±17.2 岁；65%为男性），中位随访时间为 58 个月（范围为 6 至 454 个月）。患者分为两组：通过常规检查结果（心前区杂音和/或异常心电图）偶然诊断的患者，以及因症状或因 HC 家族史筛查而诊断的患者。偶然诊断的患者占我们研究队列的 29.2%。尽管两组的总死亡率无差异（p=0.12），但因症状或家族史而诊断的患者发生心血管死亡的风险至少增加了 4.5 倍（相对风险 4.5，95%置信区间 1.04 至 19.6，p=0.04），发生猝死的风险增加了 4.22 倍（相对风险 4.22，95%置信区间 1.0 至 18.22，p=0.04）。尽管非偶然诊断患者的猝死死亡率较高，但两组之间猝死危险因素的频率无统计学差异（p=0.96）。总之，发表的登记处报告的患者数量较少与普通人群中相对较高的疾病患病率之间的差异可归因于大量无症状患者，甚至在他们的一生中都在等待偶然诊断。偶然诊断的患者具有更良性的病程，总心血管和复合猝死死亡率可证实这一点。医生对 HC 的高度认识和怀疑对于临床识别此类患者至关重要。
