Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Int J Cardiol. 2020 Nov 15;319:97-100. doi: 10.1016/j.ijcard.2020.06.015. Epub 2020 Jun 20.
Patients with obstructive hypertrophic cardiomyopathy (HCM) may have symptoms mimicking ischemic heart disease, including chest pain and shortness of breath. Some patients undergo coronary revascularization which may not lead to symptomatic improvement. This study assesses clinical presentations and outcomes of patients with previous coronary revascularization undergoing septal myectomy.
From 08/1996 to 07/2017, 166 adult patients with obstructive HCM underwent septal myectomy at our Clinic with a history of percutaneous coronary intervention (PCI, N = 153) or coronary artery bypass grafting (CABG, N = 13). We assessed their functional status before and after coronary intervention and outcomes following myectomy.
The median (IQR) age was 65 (59-71) years, and 106 (64%) were male. Among 150 patients whose extent of disease was known, single vessel disease was identified in 109 (73%) who had PCI and 1 (9%) who had CABG. Following revascularization, many (59%) reported no improvement in shortness of breath from preoperative status. Myectomy was performed at a median of 3.2 (1.0-6.3) years following coronary revascularization, and 40 (25%) required myectomy within 1 year. Patients whose shortness of breath persisted after PCI/CABG (N = 90) underwent myectomy earlier than those whose symptoms initially improved (N = 63) after coronary revascularization (1.4 [0.6-4.0] years vs. 5.1 [2.8-9.5] years, p < .001).
Almost 25% of patient's required septal myectomy within 1 year of coronary intervention for continued symptoms originally thought to be due to ischemic heart disease. These findings highlight the overlap of obstruction and ischemic symptoms and the importance of complete evaluation for dynamic obstruction in HCM.
梗阻性肥厚型心肌病（HCM）患者可能出现类似于缺血性心脏病的症状，包括胸痛和呼吸急促。一些患者接受了冠状动脉血运重建，但这可能不会导致症状改善。本研究评估了既往接受过冠状动脉血运重建的患者行间隔心肌切除术的临床表现和结局。
1996 年 8 月至 2017 年 7 月，166 例成人梗阻性 HCM 患者在我院行间隔心肌切除术，其中有经皮冠状动脉介入治疗（PCI，N=153）或冠状动脉旁路移植术（CABG，N=13）史。我们评估了患者在冠状动脉介入治疗前后的功能状态和心肌切除术后的结局。
患者的中位（IQR）年龄为 65（59-71）岁，106 例（64%）为男性。在 150 例已知疾病程度的患者中，109 例（73%）接受 PCI 的患者和 1 例（9%）接受 CABG 的患者存在单支血管病变。在血管重建后，许多（59%）患者报告呼吸急促的症状与术前相比没有改善。在冠状动脉血运重建后中位 3.2（1.0-6.3）年进行心肌切除术，其中 40 例（25%）在 1 年内需要行心肌切除术。在 PCI/CABG 后仍有呼吸困难的患者（N=90）比那些在冠状动脉血运重建后症状最初改善的患者（N=63）更早行心肌切除术（1.4[0.6-4.0]年 vs. 5.1[2.8-9.5]年，p<0.001）。
近 25%的患者在冠状动脉介入治疗后 1 年内需要行间隔心肌切除术，以治疗最初被认为是缺血性心脏病引起的症状。这些发现强调了梗阻和缺血症状的重叠，以及在 HCM 中对动态梗阻进行全面评估的重要性。
