Wu X, Cui H, Xiao M H, Lu J, Zhu C S, Wang S Y, Huang X H
*Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2016 Dec 24;44(12):1010-1014. doi: 10.3760/cma.j.issn.0253-3758.2016.12.004.
To explore the clinical characteristics and risk factors of pulmonary hypertension (PH) in patients with hypertrophic obstructive cardiomyopathy (HOCM). A total of 301 patients admitted in Fuwai Hospital and diagnosed with HOCM were included in our study. Incidence rate and severity of PH were depicted. The study population was divided into two groups (PH group and control group), and the differences in clinical profile were elucidated. Risk factors of PH in patients with HOCM were assessed by multivariate logistic regression analysis. The incidence of PH was 12.3% (37 cases), in which 48.6% patients (18 cases) were mild PH, 40.5% patients (15 cases) were moderate PH, and patients with severe PH accounts for 10.8% (4 cases). Multivariate logistic regression analysis indicated that female(=3.95, 95% 1.74-8.98, =0.001), age ≥65 years(=3.87, 95% 1.16-12.97, =0.030), history of atrial fibrillation(=2.76, 95% 1.01-7.57, =0.049)and moderate or severe mitral regurgitation(=6.63, 95% 3.02-14.57, =0.000)were independent risk factors of PH. Stratification according to sex showed that age ≥65 years(=7.79, 95% 1.35-47.26, <0.05)and moderate or severe mitral regurgitation(=9.83, 95% 2.26-42.67, <0.01)were independent risk factors of PH for male patients; while history of atrial fibrillation(=6.32, 95% 1.57-25.40, =0.01)and moderate or severe mitral regurgitation(=5.23, 95% 1.92-14.26, <0.01)were independent risk factors of PH for female patients. Risk factors were similar between the mild PH group and moderate to severe PH groups. Compared with patients without PH, HOCM patients complicated with PH were older and with higher percentage of female, and resting obstruction, history of atrial fibrillation and moderate or severe mitral regurgitation. Independent risk factors for PH in obstructive hypertrophic cardiomyopathy patients are female, advanced age, history of atrial fibrillation and moderate or severe mitral regurgitation.
探讨肥厚型梗阻性心肌病（HOCM）患者肺动脉高压（PH）的临床特征及危险因素。本研究纳入了301例在阜外医院住院并诊断为HOCM的患者。描述了PH的发生率和严重程度。将研究人群分为两组（PH组和对照组），阐明了临床特征的差异。通过多因素logistic回归分析评估HOCM患者PH的危险因素。PH的发生率为12.3%（37例），其中轻度PH患者占48.6%（18例），中度PH患者占40.5%（15例），重度PH患者占10.8%（4例）。多因素logistic回归分析表明，女性（比值比=3.95，95%置信区间1.74 - 8.98，P=0.001）、年龄≥65岁（比值比=3.87，95%置信区间1.16 - 12.97，P=0.030）、房颤病史（比值比=2.76，95%置信区间1.01 - 7.57，P=0.049）和中重度二尖瓣反流（比值比=6.63，95%置信区间3.02 - 14.57，P=0.000）是PH的独立危险因素。按性别分层显示，年龄≥65岁（比值比=7.79，95%置信区间1.35 - 47.26，P<0.05）和中重度二尖瓣反流（比值比=9.83，95%置信区间2.26 - 42.67，P<0.01）是男性患者PH的独立危险因素；而房颤病史（比值比=6.32，95%置信区间1.57 - 25.40，P=0.01）和中重度二尖瓣反流（比值比=5.23，95%置信区间1.92 - 14.26，P<0.01）是女性患者PH的独立危险因素。轻度PH组与中重度PH组的危险因素相似。与无PH的患者相比，合并PH的HOCM患者年龄更大，女性比例更高，且存在静息梗阻、房颤病史和中重度二尖瓣反流。梗阻性肥厚型心肌病患者PH的独立危险因素为女性、高龄、房颤病史和中重度二尖瓣反流。
