Hamada Mareomi, Ogimoto Akiyoshi, Ohshima Kiyotaka, Miyazaki Shigehiro, Kubota Norio, Ikeda Shuntarto, Shigematsu Yuji
Division of Cardiology, Uwajima City Hospital, 1-1 Goten-machi, Uwajima, Ehime, 798-8510, Japan.
Division of Physiological Laboratory, Uwajima City Hospital, 1-1 Goten-machi, Uwajima, Ehime, 798-8510, Japan.
Heart Vessels. 2018 Nov;33(11):1267-1274. doi: 10.1007/s00380-018-1178-5. Epub 2018 May 2.
The influence of shunts between the coronary artery (CA) and the left ventricle (LV), on chest pain (CP) in patients with hypertrophic cardiomyopathy (HCM) is unknown. We examined the incidence of CA-LV shunts and their influence on CP in HCM patients. Twenty normal control subjects (NCS), 3 with CP due to CA-LV shunts (CP patients), and 60 with HCM participated. Interventricular septal wall thickness (IVST), LV posterior wall thickness (LVPWT), cardiac and stroke indexes (CI and SI), LV end-diastolic pressure (LVEDP), and proximal diameters of the CA were measured. Twenty-five HCM patients had a CA-LV shunt (41.7%). Both IVST and LVPWT were greater in the HCM patients than in NCS and CP patients. These values showed no significant differences between the HCM with shunt and HCM without shunt groups. CI and SI were lower in the HCM patients than in NCS and CP patients. LVEDP was higher in the HCM and CP patients than in NCS. CA diameters were larger in the HCM and CP patients than in NCS. CP was found in 32 HCM patients (53%). The incidence of CP was greater in the HCM with shunt group than in HCM without shunt group (80 vs. 34%, p < 0.0005). There was no significant difference in CA diameters between the HCM patients with CP and those without CP. CA-LV shunts are often found in HCM patients and are closely related to CP. Thus, CA-LV shunts are an important factor behind CP in HCM patients.
冠状动脉（CA）与左心室（LV）之间的分流对肥厚型心肌病（HCM）患者胸痛（CP）的影响尚不清楚。我们研究了HCM患者中CA-LV分流的发生率及其对CP的影响。20名正常对照受试者（NCS）、3名因CA-LV分流导致胸痛的患者（CP患者）和60名HCM患者参与了研究。测量了室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、心脏指数和卒中指数（CI和SI）、左心室舒张末期压力（LVEDP）以及CA的近端直径。25名HCM患者存在CA-LV分流（41.7%）。HCM患者的IVST和LVPWT均高于NCS和CP患者。这些值在有分流的HCM组和无分流的HCM组之间无显著差异。HCM患者的CI和SI低于NCS和CP患者。HCM和CP患者的LVEDP高于NCS。HCM和CP患者的CA直径大于NCS。32名HCM患者（53%）出现胸痛。有分流的HCM组胸痛发生率高于无分流的HCM组（80%对34%，p<0.0005）。有胸痛的HCM患者和无胸痛的HCM患者之间CA直径无显著差异。CA-LV分流在HCM患者中经常出现，且与胸痛密切相关。因此，CA-LV分流是HCM患者胸痛的一个重要因素。
