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中隔心肌阻塞与肥厚型梗阻性心肌病患者的非持续性室性心动过速有关。

Mid-ventricular obstruction is associated with non-sustained ventricular tachycardia in patients with hypertrophic obstructive cardiomyopathy.

机构信息

Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

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

出版信息

Clin Cardiol. 2021 Apr;44(4):555-562. doi: 10.1002/clc.23575. Epub 2021 Feb 24.

Abstract

BACKGROUND

Mid-ventricular obstruction (MVO) is a rare subtype of hypertrophic cardiomyopathy (HCM) but it is associated with ventricular arrhythmia. The relationship between MVO and non-sustained ventricular tachycardia (NSVT) in HCM patients is unknown.

HYPOTHESIS

The severity of MVO increases the incidence of NSVT in patients with hypertrophic obstructive cardiomyopathy (HOCM).

METHODS

Five hundred and seventy-two consecutive patients diagnosed with HOCM in Fuwai Hospital between January 2015 and December 2017 were enrolled in this study. Holter electrocardiographic and clinical parameters were compared between HOCM patients with and without MVO.

RESULTS

Seventy-six (13.3%) of 572 patients were diagnosed with MVO. Compared to patients without MVO, those with MVO were much younger, and had a higher incidence of syncope, greater left ventricular (LV) posterior wall thickness, a higher percentage of LV late gadolinium enhancement, and higher prevalence of NSVT. Furthermore, the prevalence of NSVT increased with the severity of MVO (without, mild, moderate or severe: 11.1%, 18.2%, 25.6%, respectively, p for trend < .01). Similarly, the prevalence of NSVT differed among patients with isolated LV outflow tract (LVOTO), both MVO and LVOTO, and isolated MVO (11.1%, 21.3%, 26.6%, respectively, p for trend = .018). In addition to age, diabetes, left atrial diameter, and maximal wall thickness, multivariate analysis revealed the presence of MVO as an independent risk factor for NSVT (Odds ratio 2.69; 95% confidence interval 1.41 to 5.13, p = .003).

CONCLUSIONS

The presence and severity of MVO was associated with higher incidence of NSVT in HOCM patients.

摘要

背景

中段室间隔梗阻(MVO)是肥厚型心肌病(HCM)的一种罕见亚型,但它与室性心律失常有关。MVO 与 HCM 患者非持续性室性心动过速(NSVT)之间的关系尚不清楚。

假设

MVO 的严重程度增加了肥厚梗阻型心肌病(HOCM)患者 NSVT 的发生率。

方法

本研究纳入了 2015 年 1 月至 2017 年 12 月期间在阜外医院连续诊断为 HOCM 的 572 例患者。比较了有和无 MVO 的 HOCM 患者的动态心电图和临床参数。

结果

572 例患者中,76 例(13.3%)诊断为 MVO。与无 MVO 患者相比,MVO 患者年龄较小,晕厥发生率较高,左心室(LV)后壁厚度较大,LV 晚期钆增强比例较高,NSVT 发生率较高。此外,随着 MVO 的严重程度增加,NSVT 的发生率也随之增加(无、轻度、中度或重度:11.1%、18.2%、25.6%,趋势 p 值 < 0.01)。同样,LVOT 单纯梗阻、MVO 合并 LVOT 梗阻和单纯 MVO 患者的 NSVT 发生率也不同(11.1%、21.3%、26.6%,趋势 p 值= 0.018)。除年龄、糖尿病、左心房直径和最大壁厚度外,多变量分析还显示,MVO 的存在是 NSVT 的独立危险因素(优势比 2.69;95%置信区间 1.41 至 5.13,p = 0.003)。

结论

MVO 的存在和严重程度与 HOCM 患者 NSVT 的发生率增加有关。

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