Kim Sung-Hwan, Kim Seon-Ok, Han Seungbong, Hwang Ki Won, Lee Cheol-Whan, Nam Gi-Byoung, Choi Kee-Joon, Kim Dae Hee, Song Jong-Min, Kang Duk-Hyun, Song Jae-Kwan, Kim Cheol-Ho, Kim You-Ho
Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea.
Int Heart J. 2013;54(4):207-11. doi: 10.1536/ihj.54.207.
Although apical hypertrophic cardiomyopathy (HCM) has been considered to be more benign than asymmetric HCM, few studies have directly compared their clinical features. We compared the electrocardiographic data and longterm outcomes between patients with apical HCM versus asymmetric HCM. This retrospective study enrolled 796 patients (243 apical HCM and 553 asymmetric HCM). We assessed long-term all-cause and cardiac mortalities using an inverse probability of treatment weighted (IPTW) method and propensity score matched (PSM) analysis. In patients with asymmetric HCM, QT prolongation, QRS widening, PR prolongation, and pathologic Q wave were significantly more frequent. The incidences of early repolarization were similar (11% in apical and 12% in asymmetric HCM, P = 0.19). The median follow-up duration was 6.5 years. There was a borderline significant difference in overall survival rates between the apical and asymmetric HCM groups (73% versus 69%, log rank P = 0.38, IPTW: P = 0.05, PSM: P = 0.05). Regarding cardiac death, asymmetric HCM was more hazardous than apical HCM (89% versus 77%, log rank P = 0.04, IPTW: P = 0.03, PSM: P = 0.03). There was no electrocardiographic predictor for the long-term outcomes, although beta-blocker use was significantly associated with lower overall death (HR = 0.58, 95% CI = 0.41-0.81) and slightly lower cardiac death (HR = 0.86, 95% CI = 0.55-1.33). The overall survival rate of apical HCM was as high as that of asymmetric HCM, but the cardiac survival rate was significantly lower in patients with asymmetric HCM. Beta-blocker use was associated with better long-term outcomes.
尽管心尖肥厚型心肌病（HCM）被认为比非对称性HCM的病情更良性，但很少有研究直接比较它们的临床特征。我们比较了心尖HCM患者与非对称性HCM患者的心电图数据和长期预后。这项回顾性研究纳入了796例患者（243例心尖HCM和553例非对称性HCM）。我们使用治疗权重逆概率（IPTW）方法和倾向评分匹配（PSM）分析评估长期全因死亡率和心源性死亡率。在非对称性HCM患者中，QT间期延长、QRS波增宽、PR间期延长和病理性Q波明显更常见。早期复极的发生率相似（心尖HCM为11%，非对称性HCM为12%，P = 0.19）。中位随访时间为6.5年。心尖HCM组和非对称性HCM组的总生存率存在临界显著差异（73%对69%，对数秩检验P = 0.38，IPTW：P = 0.05，PSM：P = 0.05）。关于心源性死亡，非对称性HCM比心尖HCM更危险（89%对77%，对数秩检验P = 0.04，IPTW：P = 0.03，PSM：P = 0.03）。尽管使用β受体阻滞剂与较低的总死亡率显著相关（HR = 0.58，95%CI = 0.41 - 0.81）且心源性死亡率略低（HR = 0.86，95%CI = 0.55 - 1.33），但没有心电图指标可预测长期预后。心尖HCM的总生存率与非对称性HCM一样高，但非对称性HCM患者的心源性生存率显著更低。使用β受体阻滞剂与更好的长期预后相关。
