Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, Korea.
Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, 407 E 61st St, New York, NY, USA.
Eur Heart J Cardiovasc Imaging. 2018 Oct 1;19(10):1149-1156. doi: 10.1093/ehjci/jex234.
To establish geometric predictors of left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM) patients by use of cardiac computed tomography (CT).
A total of 141 consecutive patients with HCM who underwent cardiac CT comprised the analytic sample. The degree, pattern, and extent of left ventricular (LV) hypertrophy were evaluated using 3D CT. Abnormality of papillary muscle (PM), mitral valve, and aorto-mitral angle were evaluated quantitatively. Multivariable logistic regression analysis and sensitivity analysis were performed to reliably identify predictors of LVOTO. LVOTO was present among 40 (28.4%) patients. Those with LVOTO displayed a higher prevalence for having a spiral pattern of LV hypertrophy (e.g. 51 vs. 16%, P < 0.001), a longer anterior mitral leaflet (AML) length (e.g. 18.0 vs. 15.6 mm, P = 0.007), and a longer distance from lateral PM base to LV apex (e.g. 26.4 vs. 22.0 mm, P < 0.001), as compared with the non-LVOTO group. Multivariable logistic regression revealed all three variables [i.e. spiral pattern (95% confidence interval (CI), 3.75, 1.59-8.84); AML length (95% CI, 1.20, 1.03-1.40); the distance between lateral PM base and LV apex (95% CI, 1.09, 1.01-1.19)] retained significance after adjustment for numerous covariates.
Spiral pattern of LV hypertrophy, the length of AML, and the distance between lateral PM base and LV apex were independent predictors of LVOTO in patients with HCM.
利用心脏计算机断层扫描（CT）建立肥厚型心肌病（HCM）患者左心室流出道梗阻（LVOTO）的几何预测因子。
本分析样本包括 141 例连续接受心脏 CT 的 HCM 患者。使用 3D CT 评估左心室（LV）肥厚的程度、模式和范围。定量评估乳头肌（PM）、二尖瓣和主动脉-二尖瓣角的异常。进行多变量逻辑回归分析和敏感性分析，以可靠识别 LVOTO 的预测因子。40 例（28.4%）患者存在 LVOTO。与无 LVOTO 组相比，LVOTO 患者 LV 肥厚呈螺旋模式的比例更高（例如 51%比 16%，P<0.001），前二尖瓣瓣叶（AML）长度更长（例如 18.0 比 15.6 mm，P=0.007），以及从外侧 PM 基底到 LV 顶点的距离更长（例如 26.4 比 22.0 mm，P<0.001）。多变量逻辑回归显示，所有三个变量[即螺旋模式（95%置信区间（CI），3.75，1.59-8.84）；AML 长度（95%CI，1.20，1.03-1.40）；外侧 PM 基底与 LV 顶点之间的距离（95%CI，1.09，1.01-1.19）]在调整了许多协变量后仍具有显著性。
LV 肥厚的螺旋模式、AML 长度和外侧 PM 基底与 LV 顶点之间的距离是 HCM 患者 LVOTO 的独立预测因子。
