Doesch Christina, Lossnitzer Dirk, Rudic Boris, Tueluemen Erol, Budjan Johannes, Haubenreisser Holger, Henzler Thomas, Schoenberg Stefan O, Borggrefe Martin, Papavassiliu Theano
1. 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany ; 2. DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany.
2. DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany; 3. Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.
Int J Med Sci. 2016 Jan 1;13(1):1-7. doi: 10.7150/ijms.13530. eCollection 2016.
Atrial fibrillation (AF) is associated with clinical deterioration, stroke and disability in patients with hypertrophic cardiomyopathy (HCM). Therefore, the objective of this study was to evaluated cardiac magnetic resonance (CMR)-derived determinants for the occurrence of AF in patients with HCM.
98 Patients with HCM and 30 healthy controls underwent CMR and were followed-up for 6 ± 3 years.
19 (19.4%) patients presented with AF at initial diagnosis, 19 (19.4%) developed AF during follow-up and 60 (61.2%) remained in sinus rhythm (SR). Compared to healthy controls, patients with HCM who remained in SR presented with significantly increased left ventricular mass, an elevated left ventricular remodeling index, enlarged left atrial volumes and reduced septal mitral annular plane systolic excursion (MAPSE) compared to healthy controls. Whereas HCM patients who presented with AF at initial diagnosis and those who developed AF during follow-up additionally presented with reduced tricuspid annular plane systolic excursion (TAPSE) and right atrial (RA) dilatation. Receiver-operator curve analysis indicated good predictive performance of TAPSE, RA diameter and septal MAPSE (AUC 0.73, 0.69 and 0.71, respectively) to detect patients at risk of developing AF.
Reduced MAPSE measurements and enlarged LA volumes seems to be a common feature in patients with HCM, whereas reduced TAPSE and RA dilatation only seem to be altered in patients with history of AF and those developing AF. Therefore, they could serve as easy determinable markers of AF in patients with HCM.
心房颤动（AF）与肥厚型心肌病（HCM）患者的临床病情恶化、中风及残疾相关。因此，本研究的目的是评估心脏磁共振成像（CMR）得出的HCM患者发生AF的决定因素。
98例HCM患者和30名健康对照者接受了CMR检查，并进行了6±3年的随访。
19例（19.4%）患者在初诊时即出现AF，19例（19.4%）在随访期间发生AF，60例（61.2%）维持窦性心律（SR）。与健康对照者相比，维持SR的HCM患者左心室质量显著增加，左心室重构指数升高，左心房容积增大，与健康对照者相比，室间隔二尖瓣环平面收缩期位移（MAPSE）降低。而初诊时出现AF的HCM患者以及随访期间发生AF的患者还表现为三尖瓣环平面收缩期位移（TAPSE）降低和右心房（RA）扩张。受试者工作特征曲线分析表明，TAPSE、RA直径和室间隔MAPSE对检测有发生AF风险的患者具有良好的预测性能（AUC分别为0.73、0.69和0.71）。
MAPSE测量值降低和左心房容积增大似乎是HCM患者的常见特征，而TAPSE降低和RA扩张似乎仅在有AF病史和发生AF的患者中发生改变。因此，它们可作为HCM患者AF的易于确定的标志物。
