Rowin Ethan J, Maron Barry J, Chokshi Aalap, Maron Martin S
Division of Cardiology, Hypertrophic Cardiomyopathy Institute, Tufts Medical Center, Boston, MA, USA.
Pacing Clin Electrophysiol. 2018 Jun 12. doi: 10.1111/pace.13413.
In hypertrophic cardiomyopathy (HCM) aging has proved protective against sudden death (SD) risk and aggressive recommendations for prophylactic ICDs are uncommon in patients ≥60 years. Nevertheless, we present a patient with an unexpected but aborted sudden death event at the advanced age of 71 years due to a left ventricular apical aneurysm (LVAA) which has emerged as a novel SD marker. Subsequent reappraisal of the Tufts HCM database, specifically the 118 LVAA patients, showed that 36% of SD events occurred at ≥60 years. Of HCM patients ≥ 60 years, SD was 8-fold more common with aneurysm than without aneurysms (16% vs 2%; P < 0.001). Risk in HCM with LVAA persists throughout life and senior LVAA patients should also be considered for primary prevention of SD with the ICD.
在肥厚型心肌病（HCM）中，年龄已被证明可降低猝死（SD）风险，对于≥60岁的患者，积极推荐预防性植入式心律转复除颤器（ICD）的情况并不常见。然而，我们报告了一名71岁高龄的患者，因左心室心尖部动脉瘤（LVAA）发生了一次意外但未成功的猝死事件，LVAA已成为一种新的猝死标志物。随后对塔夫茨HCM数据库（特别是118例LVAA患者）的重新评估显示，36%的猝死事件发生在≥60岁的患者中。在≥60岁的HCM患者中，有动脉瘤的患者猝死发生率是无动脉瘤患者的8倍（16%对2%；P<0.001）。伴有LVAA的HCM患者终生都存在风险，老年LVAA患者也应考虑接受ICD进行猝死的一级预防。
