Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea.
Department of Radiology, National Cancer Center Hospital, Goyang, Gyeonggi-do, South Korea.
Eur Radiol. 2019 Sep;29(9):4593-4602. doi: 10.1007/s00330-018-5951-8. Epub 2019 Feb 22.
Chest pain is a common symptom in patients with hypertrophic cardiomyopathy (HCM), causing difficulty determining whether there is coexistent coronary artery disease (CAD). We investigated whether coronary computed tomography angiography (CCTA) can assess the prevalence and clinical significance of CAD in adult patients with HCM showing chest pain through longitudinal follow-up.
In 238 adult patients with HCM, who underwent CCTA for chest pain, we analyzed the degree of stenosis and adverse plaque characteristics (APCs) as CCTA variables. Three prediction models for adverse cardiovascular events (ACEs: all-cause mortality, myocardial infarction, unstable angina, heart failure, implantable cardioverter-defibrillator implantation, and stroke) were assessed using the combination of clinical risk factors, echocardiographic parameters, and CCTA variables.
The prevalence of obstructive CAD (≥ 50% in luminal stenosis) and APC was 14.7% and 18.9%, respectively. During the follow-up period (median, 37 months; range, 2-108 months), there were 31 occurrences of ACEs (13.0%). Using multivariate Cox regression analysis, age, atrial fibrillation, low ejection fraction, obstructive CAD, and APCs were associated with ACEs (all p < 0.05). Among the prediction models for ACEs, the area under the curve (AUC) was higher (AUC = 0.92) when CCTA variables were added to the clinical (AUC = 0.84) and echocardiographic factors (AUC = 0.88) (p < 0.001).
Using CCTA, about 20% of symptomatic HCM patients were associated with clinically significant atherosclerosis. Adding these CCTA variables to the clinical and echocardiographic variables may increase the predictions of ACEs; therefore, evaluating coronary atherosclerosis using CCTA may be helpful for symptomatic HCM patients.
• Chest pain in adult patients with hypertrophic cardiomyopathy (HCM) remains challenging to distinguish from coronary artery disease. • Coronary computed tomography angiography (CCTA) can assess the severity and characteristics of coronary atherosclerosis in symptomatic HCM patients. • Adding CCTA variables to clinical and echocardiographic factors may increase the predictions of adverse cardiac events in HCM patients, and thus evaluating coronary atherosclerosis using CCTA may be helpful for HCM patients with chest pain.
胸痛是肥厚型心肌病（HCM）患者的常见症状，这使得确定是否同时存在冠状动脉疾病（CAD）变得困难。我们通过纵向随访研究了冠状动脉计算机断层扫描血管造影（CCTA）是否可以评估有胸痛症状的成年 HCM 患者 CAD 的患病率和临床意义。
在 238 名因胸痛而行 CCTA 的成年 HCM 患者中，我们分析了狭窄程度和不良斑块特征（APCs）作为 CCTA 变量。使用临床危险因素、超声心动图参数和 CCTA 变量的组合评估了 3 种不良心血管事件（ACEs：全因死亡率、心肌梗死、不稳定型心绞痛、心力衰竭、植入式心脏复律除颤器植入和中风）的预测模型。
阻塞性 CAD（管腔狭窄≥50%）和 APC 的患病率分别为 14.7%和 18.9%。在随访期间（中位数 37 个月；范围 2-108 个月），有 31 例 ACEs（13.0%）发生。多变量 Cox 回归分析显示，年龄、心房颤动、低射血分数、阻塞性 CAD 和 APCs 与 ACEs 相关（均 p<0.05）。在 ACEs 的预测模型中，当将 CCTA 变量添加到临床（AUC=0.84）和超声心动图因素（AUC=0.88）中时，曲线下面积（AUC）更高（AUC=0.92）（p<0.001）。
使用 CCTA，约 20%的有症状 HCM 患者与临床显著动脉粥样硬化有关。将这些 CCTA 变量添加到临床和超声心动图变量中可能会增加 ACEs 的预测；因此，使用 CCTA 评估冠状动脉粥样硬化可能有助于有胸痛症状的 HCM 患者。
成人肥厚型心肌病（HCM）患者的胸痛仍然难以与冠状动脉疾病区分。
冠状动脉计算机断层扫描血管造影（CCTA）可评估有症状 HCM 患者冠状动脉粥样硬化的严重程度和特征。
将 CCTA 变量添加到临床和超声心动图因素中可能会增加 HCM 患者发生不良心脏事件的预测，因此使用 CCTA 评估冠状动脉粥样硬化可能有助于胸痛的 HCM 患者。
