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欧洲心肌病试点注册研究:欧洲心脏病学会的 EURObservational Research Programme。

European Cardiomyopathy Pilot Registry: EURObservational Research Programme of the European Society of Cardiology.

机构信息

Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK

Centre de Référence des Maladies Cardiaques Héréditaires, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France.

出版信息

Eur Heart J. 2016 Jan 7;37(2):164-73. doi: 10.1093/eurheartj/ehv497. Epub 2015 Sep 25.

Abstract

AIMS

Cardiomyopathies are a heterogeneous group of disorders associated with premature death due to ventricular arrhythmia or heart failure. The purpose of this study was to examine the characteristics of patients enrolled in the pilot phase of the EURObservational Research Programme (EORP) cardiomyopathy registry.

METHODS AND RESULTS

Between 1 December 2012 and 30 November 2013, four cardiomyopathy phenotypes were studied: hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and restrictive cardiomyopathy (RCM). Twenty-seven centres in 12 countries participated; 1115 patients were enrolled. The commonest cardiomyopathy was HCM (n = 681), followed by DCM (n = 346), ARVC (n = 59), and RCM (n = 29); 423 patients (46.4% of those reported) had familial disease; and 56 (5.0%) had rare disease phenocopies. Median age at enrolment and diagnosis was 54 [interquartile range (IQR), 42-64] and 46 years (IQR, 32-58), respectively; fewer patients with ARVC and more with RCM were diagnosed in the upper age quartile (P < 0.0001). There was a male predominance for all cardiomyopathies except RCM (P = 0.0023). Most patients were in New York Heart Association functional class I (n = 813) at enrolment; 139 (12.5%) reported syncope, most frequently in ARVC (P = 0.0009). Five hundred and seven (45.5%) patients underwent cardiac magnetic resonance imaging, 117 (10.6%) endomyocardial biopsy, and 462 (41.4%) genetic testing with a causative mutation reported in 236 individuals (51.1%). 1026 patients (92.0%) were receiving drug therapy; 316 (28.3%) had received an implantable cardioverter defibrillator (highest proportion in ARVC, P < 0.0001).

CONCLUSION

This pilot study shows that services for patients with cardiomyopathy are complex, requiring access to a large range of invasive and non-invasive investigations and involvement of multidisciplinary teams. Treatment regimens are equally multifaceted and show that patients are likely to need long-term follow-up in close liaison with expert centres.

摘要

目的

心肌病是一组与室性心律失常或心力衰竭导致的过早死亡相关的异质性疾病。本研究旨在研究 EURObservational Research Programme(EORP)心肌病注册研究的试点阶段入组患者的特征。

方法和结果

2012 年 12 月 1 日至 2013 年 11 月 30 日,研究了四种心肌病表型:肥厚型心肌病(HCM)、扩张型心肌病(DCM)、致心律失常性右心室心肌病(ARVC)和限制型心肌病(RCM)。12 个国家的 27 个中心参与了研究,共入组 1115 例患者。最常见的心肌病是 HCM(n=681),其次是 DCM(n=346)、ARVC(n=59)和 RCM(n=29);423 例(占报告病例的 46.4%)有家族性疾病;56 例(5.0%)有罕见疾病表型。入组时和诊断时的中位年龄分别为 54 岁[四分位间距(IQR),42-64]和 46 岁(IQR,32-58);ARVC 和 RCM 患者的诊断年龄较高(四分位间距,P<0.0001)。除 RCM 外,所有心肌病均以男性为主(P=0.0023)。入组时,大多数患者处于纽约心脏协会心功能分级 I 级(n=813);139 例(12.5%)报告晕厥,ARVC 最常见(P=0.0009)。507 例(45.5%)患者接受了心脏磁共振成像检查,117 例(10.6%)接受了心内膜心肌活检,462 例(41.4%)进行了基因检测,236 例(51.1%)报告存在致病突变。1026 例(92.0%)患者接受药物治疗;316 例(28.3%)植入了植入式心脏复律除颤器(ARVC 比例最高,P<0.0001)。

结论

这项试点研究表明,心肌病患者的服务复杂,需要进行广泛的侵入性和非侵入性检查,并需要多学科团队的参与。治疗方案同样复杂多样,表明患者可能需要在与专家中心密切联系的情况下进行长期随访。

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