Kim Hyungseop, Park Jung-Ho, Won Ki-Bum, Yoon Hyuck-Jun, Park Hyoung-Seob, Cho Yun-Kyeong, Nam Chang-Wook, Han Seongwook, Hur Seung-Ho, Kim Yoon-Nyun, Kim Kwon-Bae
Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
Heart. 2016 Aug 1;102(15):1215-20. doi: 10.1136/heartjnl-2015-309121. Epub 2016 Mar 11.
Apical hypertrophic cardiomyopathy (HCM) is characterised by apical systolic obliteration and is associated with atrial fibrillation (AF), stroke, heart failure (HF), and mortality. We investigated whether apical obliteration of the left ventricular (LV) cavity could have an unfavourable impact on the clinical course of apical HCM.
188 patients with apical HCM (114 males, median age 67 years) were identified retrospectively from January 2008 to December 2010. The rate of apical obliteration was defined as the net obliteration to end-diastolic apical cap thickness, and the ratio of obliteration to cavity was defined as the end-systolic obliteration to cavity height. Events were defined as a composite of new onset of AF, stroke, HF, and cardiovascular (CV) death.
There were 43 clinical events (19 AFs, 11 HFs, 9 strokes, and 4 deaths) during a follow-up of median 4.4 years. The events patients were older, had larger left atrial volume index (LAVI), lower late diastolic mitral annular tissue Doppler velocity (a'), and higher LV end-diastolic pressure (E/e'). They had greater apical thickness and obliteration, smaller systolic cavity height, higher rate of obliteration, and higher ratio of obliteration to cavity; events were significantly higher (54%) in the upper tertiles of the ratio of obliteration to cavity. Age, E/e', a', LAVI, apical thickness, rate of obliteration, and ratio of obliteration to cavity were associated with events. On multivariable analysis, the ratio of obliteration to cavity remained a significant predictor.
The ratio of obliteration to cavity could provide useful information to predict the occurrence of adverse events in apical HCM.
心尖肥厚型心肌病（HCM）的特征是心尖部收缩期闭塞，且与心房颤动（AF）、中风、心力衰竭（HF）及死亡率相关。我们研究了左心室（LV）腔的心尖部闭塞是否会对心尖肥厚型心肌病的临床病程产生不利影响。
回顾性纳入2008年1月至2010年12月期间188例心尖肥厚型心肌病患者（114例男性，中位年龄67岁）。心尖部闭塞率定义为舒张末期心尖帽厚度的净闭塞值，闭塞与腔径的比值定义为收缩末期闭塞值与腔高的比值。事件定义为新发房颤、中风、心力衰竭和心血管（CV）死亡的复合事件。
在中位4.4年的随访期间，共发生43例临床事件（19例房颤、11例心力衰竭、9例中风和4例死亡）。发生事件的患者年龄较大，左心房容积指数（LAVI）较大，舒张晚期二尖瓣环组织多普勒速度（a'）较低，左心室舒张末期压力（E/e'）较高。他们的心尖部厚度和闭塞程度更大，收缩期腔高更小，闭塞率更高，闭塞与腔径的比值更高；在闭塞与腔径比值的上三分位数中，事件发生率显著更高（54%）。年龄、E/e'、a'、LAVI、心尖部厚度、闭塞率和闭塞与腔径的比值与事件相关。多变量分析显示，闭塞与腔径的比值仍然是一个显著的预测因素。
闭塞与腔径的比值可为预测心尖肥厚型心肌病不良事件的发生提供有用信息。
