Division of Cardiology, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Division of Cardiology, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Korea.
Korean Circ J. 2015 Jan;45(1):38-43. doi: 10.4070/kcj.2015.45.1.38. Epub 2015 Jan 26.
Apical hypertrophic cardiomyopathy (AHCM) is an uncommon variant of hypertrophic cardiomyopathy with a relatively benign course. However, the prognostic factors of AHCM-particularly those associated with coronary artery disease (CAD) and its anatomical subtypes-are not well known.
We enrolled 98 consecutive patients with AHCM who underwent coronary angiography or coronary computed tomography scanning at two general hospitals in Korea from January 2002 to March 2012. Patient charts were reviewed for information regarding cardiovascular (CV) risk factors, symptoms, and occurrence of CV events and/or mortality. We also reviewed echocardiographic data and angiography records.
The mean age at the time of enrollment was 61.45±9.78 years, with female patients comprising 38.6%. The proportions of mixed and pure types of AHCM were 34.4% and 65.6%, respectively. CAD was found in 31 (31.6%) patients. The mean follow-up period was 53.1±60.7 months. CV events occurred in 22.4% of patients, and the mortality rate was 5.1%. The mixed-type was more frequent in CV event group although this difference was not statistically significant (50% vs. 30%, p=0.097). The presence of CAD emerged as an independent risk factor for CV events in univariate and multivariate Cox regression analysis after adjusting for other CV risk factors.
Coronary artery disease is an independent risk factor for CV events in AHCM patients. However, AHCM without CAD has a benign natural course, comparable with the general population.
心尖肥厚型心肌病（AHCM）是肥厚型心肌病的一种罕见变异，具有相对良性的病程。然而，AHCM 的预后因素，特别是与冠状动脉疾病（CAD）及其解剖亚型相关的因素，尚未得到充分认识。
我们纳入了 2002 年 1 月至 2012 年 3 月在韩国的两家综合医院接受冠状动脉造影或冠状动脉计算机断层扫描的 98 例连续 AHCM 患者。查阅患者病历以获取心血管（CV）危险因素、症状、CV 事件和/或死亡率发生情况的信息。我们还回顾了超声心动图数据和血管造影记录。
入组时的平均年龄为 61.45±9.78 岁，女性占 38.6%。混合和纯型 AHCM 的比例分别为 34.4%和 65.6%。31 例（31.6%）患者存在 CAD。平均随访时间为 53.1±60.7 个月。22.4%的患者发生 CV 事件，死亡率为 5.1%。CV 事件组中混合型更为常见，但差异无统计学意义（50%比 30%，p=0.097）。在调整其他 CV 危险因素后，单因素和多因素 Cox 回归分析显示，CAD 的存在是 CV 事件的独立危险因素。
CAD 是 AHCM 患者 CV 事件的独立危险因素。然而，无 CAD 的 AHCM 具有与普通人群相当的良性自然病程。
