肥厚型心肌病患者植入起搏器后全因死亡率的超声心动图预测因素

Echocardiographic Predictors of All-Cause Mortality in Patients with Hypertrophic Cardiomyopathy following Pacemaker Implantation.

作者信息

Zhang Nixiao, Hua Wei, Li Xiaoping, Hu Yiran, Niu Hongxia, Cai Chi, Gu Min, Chen Xuhua, Zhang Shu

机构信息

Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.

Hospital of the University of Electronic Science and Technology of China and Sichuan Provincial People's Hospital, Chengdu 610072, China.

出版信息

Cardiol Res Pract. 2020 Feb 14;2020:2923767. doi: 10.1155/2020/2923767. eCollection 2020.

DOI:10.1155/2020/2923767

PMID:32148950

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7042507/

Abstract

OBJECTIVES

To examine the association between the echocardiographic parameters measured as left atrial diameter (LAD) and left ventricular end-diastolic diameter (LVEDD) and long-term risk of all-cause mortality in adults with hypertrophic cardiomyopathy (HCM) following pacemaker implantation.

METHODS

A total of 94 adult patients with HCM who underwent pacemaker implantation from November 2002 to June 2013 in our Arrhythmia Center for symptomatic bradycardia and did not receive an implantable cardiac defibrillator (ICD) or cardiac resynchronization therapy (CRT) during follow-up were retrospectively extracted.

RESULTS

After careful examination of the medical records, we retrospectively evaluated the clinical characteristics of 74 patients with LAD records (58.1 ± 14.9 years) and 76 patients with LVEDD records (57.6 ± 15.2 years). Based on the receiver-operating characteristic (ROC) curve, the values of LAD = 44 mm and LVEDD = 43 mm were identified to predict the all-cause mortality. In the Kaplan–Meier survival, LAD ≥44 mm and LVEDD ≥43 mm were both significantly associated with all-cause mortality (log-rank test P < 0.05). Cox regression analysis indicated that LAD ≥44 mm (HR 3.580; 95% CI = 1.055–12.148; P=0.041) was an independent predictor of all-cause mortality, while LVEDD ≥43 mm was not significantly associated with all-cause mortality. LVOTO was also significantly associated with all-cause mortality (HR = 0.166; 95% CI = 0.036–0.771; P=0.022).

CONCLUSIONS

In HCM patients with pacemaker implantation, LAD ≥44 mm was an independent predictor of all-cause mortality.

摘要

目的

探讨肥厚型心肌病（HCM）成人患者起搏器植入后，以左心房直径（LAD）和左心室舒张末期直径（LVEDD）测量的超声心动图参数与全因死亡长期风险之间的关联。

方法

回顾性提取2002年11月至2013年6月在我院心律失常中心因症状性心动过缓接受起搏器植入且随访期间未接受植入式心脏除颤器（ICD）或心脏再同步治疗（CRT）的94例成年HCM患者。

结果

仔细查阅病历后，我们回顾性评估了74例有LAD记录患者（58.1±14.9岁）和76例有LVEDD记录患者（57.6±15.2岁）的临床特征。根据受试者工作特征（ROC）曲线，确定LAD = 44 mm和LVEDD = 43 mm的值可预测全因死亡。在Kaplan-Meier生存分析中，LAD≥44 mm和LVEDD≥43 mm均与全因死亡显著相关（对数秩检验P < 0.05）。Cox回归分析表明，LAD≥44 mm（HR 3.580；95%CI = 1.055 - 12.148；P = 0.041）是全因死亡的独立预测因素，而LVEDD≥43 mm与全因死亡无显著关联。左心室流出道梗阻（LVOTO）也与全因死亡显著相关（HR = 0.166；95%CI = 0.036 - 0.771；P = 0.022）。