主动脉僵硬度独立预测肥厚型心肌病患者的运动能力：一项多模态影像学研究。

Aortic stiffness independently predicts exercise capacity in hypertrophic cardiomyopathy: a multimodality imaging study.

机构信息

Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.

出版信息

Heart. 2010 Aug;96(16):1303-10. doi: 10.1136/hrt.2009.191478.

DOI:10.1136/hrt.2009.191478

PMID:20659950

Abstract

BACKGROUND

Exercise capacity in patients with hypertrophic cardiomyopathy (HCM) varies despite similar diastolic dysfunction, left ventricular outflow tract (LVOT) obstruction and mitral regurgitation (MR). Pulse wave velocity (PWV), determined by cardiac magnetic resonance (CMR), measures aortic stiffness and is abnormal in patients with HCM in comparison with controls.

OBJECTIVE

To determine potential clinical and imaging predictors of peak oxygen consumption (pVO(2)) in patients with HCM.

METHODS

Fifty newly referred patients with HCM (62% men, 44+/-13 years, 90% receiving optimal drugs, 18% hypertensive) underwent Doppler echocardiography (transthoracic echocardiography (TTE)), cardiopulmonary exercise testing and CMR for symptom evaluation. TTE variables (diastology, post exercise MR and LVOT gradient (mmHg)), pVO(2) (ml/kg/min) and CMR variables (PWV (aortic path length between mid- and descending aorta/time delay between arrival of the foot of the pulse wave between two points, m/s), and LV volumetric indices) were measured.

RESULTS

After exercise LVOT gradient, MR, deceleration time and pVO(2) were 104+/-52, 1+/-1, 240+/-79 ms, and 25+/-6, respectively. Mean basal septal thickness (cm), PWV, EF, ESV index (ml/m(2)), EDV index (ml/m(2)) and LV mass index (g/m(2)) were 1.9+/-0.5, 9.3+/-7, 64%+/-7, 32+/-9, 87+/-17 and 112+36, respectively. Multiple regression analyses showed that only age (beta=-0.38, p=0.004) and PWV (beta=-0.33, p=0.01) predicted pVO(2).

CONCLUSION

In patients with HCM, age and PWV are predictors of pVO(2), independent of LV thickness, LVOT gradient and diastolic indices. Aortic stiffness potentially has a role in evaluation of symptoms of patients with HCM.

摘要

背景

尽管肥厚型心肌病（HCM）患者存在相似的舒张功能障碍、左心室流出道（LVOT）阻塞和二尖瓣反流（MR），但其运动能力却存在差异。通过心脏磁共振（CMR）确定的脉搏波速度（PWV）可测量主动脉僵硬度，与对照组相比，HCM 患者的 PWV 异常。

目的

确定肥厚型心肌病患者峰值耗氧量（pVO₂）的潜在临床和影像学预测因子。

方法

50 例新确诊的肥厚型心肌病患者（62%为男性，年龄 44±13 岁，90%接受最佳药物治疗，18%为高血压患者）接受了多普勒超声心动图（经胸超声心动图（TTE））、心肺运动测试和 CMR 检查，以评估症状。测量 TTE 变量（舒张功能、运动后 MR 和 LVOT 梯度（mmHg））、pVO₂（ml/kg/min）和 CMR 变量（PWV（主动脉路径长度在中降主动脉之间/两点之间脉搏波到达足部的时间延迟，m/s）和 LV 容积指数）。

结果

运动后 LVOT 梯度、MR、减速时间和 pVO₂分别为 104±52、1±1、240±79ms 和 25±6。平均基底部室间隔厚度（cm）、PWV、EF、ESV 指数（ml/m²）、EDV 指数（ml/m²）和 LV 质量指数（g/m²）分别为 1.9±0.5、9.3±7、64%±7、32±9、87±17 和 112±36。多元回归分析显示，只有年龄（β=-0.38，p=0.004）和 PWV（β=-0.33，p=0.01）可预测 pVO₂。