评估酒精消融肥厚型梗阻性心肌病患者室间隔肥厚后左心室肥厚的消退情况。

An assessment of regression of left ventricular hypertrophy following alcohol ablation of the interventricular septum in patients with hypertrophic cardiomyopathy with left ventricular outflow tract obstruction.

机构信息

Department of Interventional Cardiology and Angiology, Independent Haemodynamics Laboratory, Institute of Cardiology, Warsaw, Poland.

出版信息

Kardiol Pol. 2012;70(8):782-8.

PMID:22933209

Abstract

BACKGROUND

Hypertrophic obstructive cardiomyopathy (HOCM) is characterised by asymmetric myocardial hypertrophy, which is most pronounced in the interventricular septum (IVS) and is responsible for the dynamic obstruction of the left ventricular outflow tract (LVOT). Successful alcohol septal ablation (ASA) of the IVS allows to reduce the thickness of the parabasal part of the IVS myocardium and, in most cases, to permanently reduce the gradient in the LVOT.

AIM

To assess, using cardiac magnetic resonance imaging (MRI) and transthoracic echocardiography (TTE), the impact of gradient reduction in the LVOT on the type and severity of left ventricular (LV) remodelling.

METHODS

The study included 30 patients (aged 56.9 ± 11.9 years) with HOCM and the mean peak gradient (PG) in the LVOT of 123 ± 33 mm Hg who underwent ASA. MRI measurements were performed before and at 6 months after ASA and TTE measurements were performed before, at 3 months and at 6 months after ASA.

RESULTS

PG in the LVOT decreased to an average of 52 ± 37 mm Hg (p 〈 0.0001) at 3 months after ASA and to 37 ± 28 mm Hg (p 〈 0.0001) at 6 months after ASA. TTE revealed a decrease in IVS thickness outside the scar following ASA from 23.6 ± 3.5 mm to 19.3 ± 4.0 mm (p 〈 0.0001) and 19.4 ± 0.4 mm (p 〈 0.0001) at 3 and 6 months, respectively. There was also a decrease in lateral wall (PW) thickness from 15.9 ± 3.2 mm to 14.9 ± 2.9 mm (p = 0.046) and 14.16 ± 2.00 (p = 0.0065) at 3 and 6 months, respectively. MRI revealed a decrease in IVS thickness from 23.7 ± 2.8 mm to 18.04 ± 4.00 mm (p = 0.0001) at 6 months following ASA. We observed a regression of the PW hypertrophy from 13.2 ± 3.35 mm to 12.18 ± 2.4 mm (p = 0.0225). There was a decrease in IVS mass from 108.9 ± 20 g to 91.5 ± 29 g (p = 0.0006). There was a trend towards a decreased LV mass and LV mass excluding IVS mass at 6 months.

CONCLUSIONS

A significant decrease in PG in the LVOT is associated with a decrease in LV mass and with regression of LV hypertrophy outside the scar after ASA.

摘要

背景

肥厚型梗阻性心肌病（HOCM）的特征是不对称性心肌肥厚，最明显的部位是室间隔（IVS），并导致左心室流出道（LVOT）的动态阻塞。IVS 的成功酒精室间隔消融（ASA）允许减少 IVS 心肌的基底部分的厚度，并在大多数情况下永久降低 LVOT 中的梯度。

目的

使用心脏磁共振成像（MRI）和经胸超声心动图（TTE）评估 LVOT 中梯度降低对左心室（LV）重塑的类型和严重程度的影响。

方法

该研究包括 30 名（年龄 56.9 ± 11.9 岁）患有 HOCM 和 LVOT 中平均峰值梯度（PG）为 123 ± 33mmHg 的患者，他们接受了 ASA。MRI 测量在 ASA 前后 6 个月进行，TTE 测量在 ASA 前后 3 个月和 6 个月进行。

结果

LVOT 中的 PG 在 ASA 后 3 个月平均降低至 52 ± 37mmHg（p 〈 0.0001），6 个月后降低至 37 ± 28mmHg（p 〈 0.0001）。TTE 显示 ASA 后 IVS 厚度在疤痕外从 23.6 ± 3.5mm 减少至 19.3 ± 4.0mm（p 〈 0.0001）和 19.4 ± 0.4mm（p 〈 0.0001），分别在 3 和 6 个月。外侧壁（PW）厚度也从 15.9 ± 3.2mm 减少至 14.9 ± 2.9mm（p = 0.046）和 14.16 ± 2.00（p = 0.0065），分别在 3 和 6 个月。MRI 显示 ASA 后 6 个月 IVS 厚度从 23.7 ± 2.8mm 减少至 18.04 ± 4.00mm（p = 0.0001）。PW 肥大从 13.2 ± 3.35mm 减少至 12.18 ± 2.4mm（p = 0.0225）。IVS 质量从 108.9 ± 20g 减少至 91.5 ± 29g（p = 0.0006）。6 个月时，LV 质量和不包括 IVS 质量的 LV 质量呈下降趋势。