van der Velde Nikki, Huurman Roy, Yamasaki Yuzo, Kardys Isabella, Galema Tjebbe W, Budde Ricardo Pj, Zijlstra Felix, Krestin Gabriel P, Schinkel Arend Fl, Michels Michelle, Hirsch Alexander
Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
Am J Cardiol. 2020 May 1;125(9):1404-1412. doi: 10.1016/j.amjcard.2020.02.002. Epub 2020 Feb 8.
The etiology of chest pain in hypertrophic cardiomyopathy (HC) is diverse and includes coronary artery disease (CAD) as well as HC-specific causes. Myocardial bridging (MB) has been associated with HC, chest pain, and accelerated atherosclerosis. We compared HC patients with age-, gender- and CAD pre-test probability-matched outpatients presenting with chest pain to investigate differences in the presence of MB and CAD using coronary computed tomography angiography (CCTA). We studied 84 HC patients who underwent CCTA and compared these with 168 matched controls (age 54 ± 11 years, 70% men, pre-test probability 12% [5% to 32%]). MB, calcium score, plaque morphology and presence and extent of CAD were assessed for each patient. Linear mixed models were used to assess differences between cases and controls. MB was more often seen in HC patients (50% vs 25%, p <0.001). Calcium score and the presence of obstructive CAD were similar in both groups (9 [0 to 225] vs 4 [0 to 82] and 18% vs 19%; p = 0.22 and p = 0.82). In the HC group, MB was associated with pathogenic DNA variants (p = 0.04), but not with the presence of chest pain (74% vs 76%, p = 0.8), nor with worse outcome (log-rank p = 0.30). In conclusion, the prevalence and extent of CAD was equal among patients with and without HC, demonstrating that pre-test risk prediction using the CAD Consortium clinical risk score performs well in HC patients. MB was twice as prevalent in the HC group compared with matched controls, but was not associated with chest pain or decreased event-free survival in these patients.
肥厚型心肌病（HC）胸痛的病因多种多样，包括冠状动脉疾病（CAD）以及HC特有的病因。心肌桥（MB）与HC、胸痛和动脉粥样硬化加速有关。我们将HC患者与年龄、性别和CAD预测试概率匹配的胸痛门诊患者进行比较，以使用冠状动脉计算机断层扫描血管造影（CCTA）研究MB和CAD存在情况的差异。我们研究了84例接受CCTA的HC患者，并将其与168例匹配的对照组（年龄54±11岁，70%为男性，预测试概率12%[5%至32%]）进行比较。对每位患者评估MB、钙化积分、斑块形态以及CAD的存在情况和范围。使用线性混合模型评估病例组和对照组之间的差异。MB在HC患者中更常见（50%对25%，p<0.001）。两组的钙化积分和阻塞性CAD的存在情况相似（9[0至225]对4[0至82]以及18%对19%；p = 0.22和p = 0.82）。在HC组中，MB与致病性DNA变异相关（p = 0.04），但与胸痛的存在无关（74%对76%，p = 0.8），也与较差的预后无关（对数秩检验p = 0.30）。总之，有HC和无HC患者的CAD患病率和范围相等，表明使用CAD联盟临床风险评分进行预测试风险预测在HC患者中表现良好。与匹配的对照组相比，HC组中MB的患病率是其两倍，但与这些患者的胸痛或无事件生存期缩短无关。
