Ichida Masaru, Nishimura Yoshioki, Kario Kazuomi
Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
J Cardiol. 2014 Oct;64(4):265-72. doi: 10.1016/j.jjcc.2014.02.011. Epub 2014 Mar 25.
Some patients with hypertrophic cardiomyopathy (HCM) develop left ventricular apical aneurysm, leading to serious cardiovascular complications. The aims of this study were to identify the incidence and clinical course of HCM patients with apical aneurysms in Japan, and to evaluate the role of electrocardiography (ECG) as a screening test to detect apical aneurysms in HCM patients.
In a retrospective, single center analysis of a population of 247 HCM patients, 21 patients (8.5%) had left ventricular apical aneurysms. Their mean age was 60 ± 14 years (range: 23-77 years) at study entry. Over 4.7 ± 3.3 years of follow-up, 10 patients (47.6%) experienced an adverse clinical event (annual event rate: 10.1%/y), including five implantable cardioverter-defibrillator (ICD) implantations for ventricular tachycardia/ventricular fibrillation (VT/VF), an appropriate discharge of ICD for VT/VF, and four nonfatal thromboembolic strokes. Two patients developed systolic dysfunction (ejection fraction <50%). No sudden cardiac death or progressive heart failure was detected. Fourteen patients showed ST-segment elevation (≥ 1 mm) in V3 through V5 of ECG. In four patients, progression of the ST-segment elevation was recognized. When the ST-segment elevation was used to identify apical aneurysms in HCM patients, the sensitivity was 66.7%, and the specificity was 98.7%.
Apical aneurysms in HCM patients in Japan are not rare, and are associated with serious cardiovascular complications. The early diagnosis of apical aneurysms can be achieved by serial ECG.
一些肥厚型心肌病（HCM）患者会发生左心室心尖部动脉瘤，导致严重的心血管并发症。本研究的目的是确定日本HCM合并心尖部动脉瘤患者的发病率和临床病程，并评估心电图（ECG）作为检测HCM患者心尖部动脉瘤筛查试验的作用。
在一项对247例HCM患者的回顾性单中心分析中，21例（8.5%）患者有左心室心尖部动脉瘤。研究开始时他们的平均年龄为60±14岁（范围：23 - 77岁）。在4.7±3.3年的随访中，10例（47.6%）患者发生了不良临床事件（年事件发生率：10.1%/年），包括5例因室性心动过速/心室颤动（VT/VF）植入植入式心脏复律除颤器（ICD）、ICD对VT/VF的恰当放电以及4例非致命性血栓栓塞性中风。2例患者出现收缩功能障碍（射血分数<50%）。未检测到心源性猝死或进行性心力衰竭。14例患者心电图V3至V5导联ST段抬高（≥1mm）。4例患者ST段抬高有进展。当用ST段抬高来识别HCM患者的心尖部动脉瘤时，敏感性为66.7%，特异性为98.7%。
日本HCM患者的心尖部动脉瘤并不罕见，且与严重的心血管并发症相关。通过连续心电图可实现心尖部动脉瘤的早期诊断。
