Casanova José David, Carrillo Josefa González, Jiménez Jesús Martín, Muñoz Javier Cuenca, Esparza Carmen Muñoz, Alvárez Marcos Siguero, Escribá Rubén, Milla Esther Burillo, de la Pompa José Luis, Raya Ángel, Gimeno Juan Ramón, Molina María Sabater, García Gregorio Bernabé
Departamento de Ingeniería y Tecnología de Computadores, Universidad de Murcia, Espinardo, 30100 Murcia, Spain.
Unidad CSUR de Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, El Palmar, 30120 Murcia, Spain.
J Clin Med. 2020 Sep 30;9(10):3171. doi: 10.3390/jcm9103171.
Hypertrophic cardiomyopathy (HCM) is often accompanied by increased trabeculated myocardium (TM)-which clinical relevance is unknown. We aim to measure the left ventricular (LV) mass and proportion of trabeculation in an HCM population and to analyze its clinical implication.
We evaluated 211 patients with HCM (mean age 47.8 ± 16.3 years, 73.0% males) with cardiac magnetic resonance (CMR) studies. LV trabecular and compacted mass were measured using dedicated software for automatic delineation of borders. Mean compacted myocardium (CM) was 160.0 ± 62.0 g and trabecular myocardium (TM) 55.5 ± 18.7 g. The percentage of trabeculated myocardium (TM%) was 26.7% ± 6.4%. Females had significantly increased TM% compared to males (29.7 ± 7.2 vs. 25.6 ± 5.8, < 0.0001). Patients with LVEF < 50% had significantly higher values of TM% (30.2% ± 6.0% vs. 26.6% ± 6.4%, = 0.02). Multivariable analysis showed that female gender and neutral pattern of hypertrophy were directly associated with TM%, while dynamic obstruction, maximal wall thickness and LVEF% were inversely associated with TM%. There was no association between TM% with arterial hypertension, physical activity, or symptoms. Atrial fibrillation and severity of hypertrophy were the only variables associated with cardiovascular death. Multivariable analysis failed to demonstrate any correlation between TM% and arrhythmias.
Approximately 25% of myocardium appears non-compacted and can automatically be measured in HCM series. Proportion of non-compacted myocardium is increased in female, non-obstructives, and in those with lower contractility. The amount of trabeculation might help to identify HCM patients prone to systolic heart failure.
肥厚型心肌病（HCM）常伴有心肌小梁增多（TM），但其临床意义尚不清楚。我们旨在测量HCM患者群体的左心室（LV）质量和小梁比例，并分析其临床意义。
我们对211例HCM患者（平均年龄47.8±16.3岁，73.0%为男性）进行了心脏磁共振（CMR）研究。使用专用软件自动勾勒边界来测量左心室小梁和致密心肌质量。平均致密心肌（CM）为160.0±62.0g，小梁心肌（TM）为55.5±18.7g。心肌小梁化百分比（TM%）为26.7%±6.4%。女性的TM%显著高于男性（29.7±7.2对25.6±5.8，P<0.0001）。左心室射血分数（LVEF）<50%的患者TM%值显著更高（30.2%±6.0%对26.6%±6.4%，P=0.02）。多变量分析显示，女性性别和中性肥厚模式与TM%直接相关，而动态梗阻、最大壁厚和LVEF%与TM%呈负相关。TM%与动脉高血压、体力活动或症状之间无关联。心房颤动和肥厚严重程度是与心血管死亡相关的唯一变量。多变量分析未能证明TM%与心律失常之间存在任何相关性。
在HCM系列中，约25%的心肌呈非致密化，可自动测量。女性、非梗阻性患者以及收缩性较低的患者中非致密心肌比例增加。小梁化程度可能有助于识别易发生收缩性心力衰竭的HCM患者。
