Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, Mass 02111, USA.
Circ Heart Fail. 2010 Sep;3(5):574-9. doi: 10.1161/CIRCHEARTFAILURE.109.922872. Epub 2010 Aug 24.
Heart transplant is a treatment option for selected patients with hypertrophic cardiomyopathy (HCM). However, the prevalence, clinical profile, and outcome of this subgroup of HCM patients are uncertain. Therefore, we sought to determine the occurrence, clinical characteristics, and prognosis of HCM patients who underwent cardiac transplantation in the United States during a 15-year period.
Demographic, clinical, and survival outcomes of 26 706 adult (age ≥18 years), heart-only transplant recipients between January 1990 and December 2004 were acquired from the United Network of Organ Sharing Registry. Pretransplant diagnoses were classified as follows: HCM (n=303, 1%) and non-HCM (26 403, 99%), comprising 3 patient subgroups: (1) ischemic cardiomyopathy (n=14 308, 54%), (2) dilated cardiomyopathy (n=11 760, 44%), and (3) restrictive cardiomyopathy (n=335, 1%). Study follow-up began at the time of heart transplant and was 76±44 months (mean±SD) among survivors. The 1-, 5-, and 10-year overall transplant survival for HCM patients was 85%, 75%, and 61%, respectively, with a trend toward greater survival compared with that of non-HCM transplant patients (82%, 70%, and 49%, respectively; log-rank test, P=0.05). However, propensity-matched, covariate-adjusted, Cox regression model analysis showed better survival over time (P<0.01) among the HCM patients. When HCM posttransplant survival was compared with that in each of the non-HCM patient subgroups, HCM patients had more favorable survival than did those transplanted for ischemic cardiomyopathy (P=0.02). In contrast, HCM posttransplant survival did not differ from that of patients transplanted for restrictive (P=0.08) or dilated (P=0.25) cardiomyopathy.
HCM patients compose a small subset (1%) of the overall population of patients who undergo heart transplantation in the United States. Nonetheless, survival after transplant among HCM patients is comparable to that of patients transplanted for non-HCM cardiovascular diseases, with possible enhanced survival over time.
心脏移植是治疗特定肥厚型心肌病（HCM）患者的一种选择。然而，这一小部分 HCM 患者的患病率、临床特征和预后尚不确定。因此，我们试图确定在美国，在 15 年期间进行心脏移植的 HCM 患者的发生情况、临床特征和预后。
从 1990 年 1 月至 2004 年 12 月的美国器官共享网络登记处获得了 26706 名成年（年龄≥18 岁）、仅心脏移植受者的人口统计学、临床和生存结果。移植前诊断分为以下几类：HCM（n=303，1%）和非 HCM（26403，99%），包括 3 个患者亚组：（1）缺血性心肌病（n=14308，54%）、（2）扩张型心肌病（n=11760，44%）和（3）限制型心肌病（n=335，1%）。研究随访从心脏移植开始，幸存者的平均随访时间为 76±44 个月（均值±标准差）。HCM 患者的 1、5 和 10 年总移植生存率分别为 85%、75%和 61%，与非 HCM 移植患者的生存率（分别为 82%、70%和 49%）相比呈上升趋势（对数秩检验，P=0.05）。然而，倾向评分匹配、协变量调整的 Cox 回归模型分析显示，HCM 患者的生存时间随着时间的推移而改善（P<0.01）。当 HCM 移植后生存率与非 HCM 患者的每个亚组进行比较时，HCM 患者的生存率明显优于因缺血性心肌病而移植的患者（P=0.02）。相比之下，HCM 移植后生存率与因限制型（P=0.08）或扩张型（P=0.25）心肌病而移植的患者没有差异。
HCM 患者占美国接受心脏移植的总体人群的一小部分（1%）。尽管如此，HCM 患者移植后的生存率与非 HCM 心血管疾病患者相似，并且随着时间的推移可能会有更好的生存。
