Center of Cardiomyopathies and Inherited Cardiac Diseases, 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece.
Center of Cardiomyopathies and Inherited Cardiac Diseases, 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece.
Int J Cardiol. 2021 Jun 1;332:127-132. doi: 10.1016/j.ijcard.2021.03.056. Epub 2021 Mar 29.
The aim of this study was to systematically review and quantitatively synthesize existing evidence about the prognostic value of LV apical aneurysm in patients with HCM.
Hypertrophic cardiomyopathy (HCM) represents a common inherited heart disease associated with enormous diversity in morphologic expression and clinical course. With the increasing penetration of advanced high resolution cardiovascular imaging into routine HCM practice, a subset of HCM patients with left ventricular (LV) apical aneurysm have become more widely recognized.
Medline was searched for studies describing the prognostic implication of LV apical aneurysm in patients with HCM. In the main analysis the combined endpoint of major HCM-related outcomes was assessed. Separate analyses for sudden cardiac death (SCD) events and thromboembolic events were also performed.
Six studies comprising of 2382 patients met the inclusion criteria. In the pooled analysis, the presence of LV apical aneurysm was significantly associated with major adverse outcomes (pooled OR: 5.13, 95 CI: 2.85 to 9.23, I:31%), increased risk of SCD arrhythmic events (pooled OR: 4.67, 95% CI: 2.30 to 9.48, I: 38%) and thromboembolic events (pooled OR: 6.30, 95% CI: 1.52 to 26.19, I: 66%).
These data demonstrate that LV apical aneurysm in HCM patients is associated with an increased risk for SCD events and thromboembolism. This finding might encourage the inclusion of LV apical aneurysm into the HCM SCD risk stratification algorithm as a novel risk marker that supports consideration for primary prevention implantable cardioverter defibrillator and anticoagulation for stroke prophylaxis.
本研究旨在系统回顾和定量综合现有的关于肥厚型心肌病（HCM）患者左室心尖部瘤预后价值的证据。
肥厚型心肌病（HCM）是一种常见的遗传性心脏病，形态表现和临床过程存在巨大差异。随着先进的高分辨率心血管成像在常规 HCM 实践中的广泛应用，越来越多的 HCM 患者伴有左心室（LV）心尖部瘤。
通过 Medline 搜索描述 HCM 患者 LV 心尖部瘤预后意义的研究。在主要分析中，评估了主要 HCM 相关结局的联合终点。还分别对心脏性猝死（SCD）事件和血栓栓塞事件进行了分析。
纳入的 6 项研究共包括 2382 例患者。在汇总分析中，LV 心尖部瘤的存在与主要不良结局显著相关（合并 OR：5.13，95%CI：2.85 至 9.23，I：31%），SCD 心律失常事件风险增加（合并 OR：4.67，95%CI：2.30 至 9.48，I：38%）和血栓栓塞事件（合并 OR：6.30，95%CI：1.52 至 26.19，I：66%）。
这些数据表明，HCM 患者的 LV 心尖部瘤与 SCD 事件和血栓栓塞的风险增加相关。这一发现可能鼓励将 LV 心尖部瘤纳入 HCM SCD 风险分层算法，作为一种新的风险标志物，支持考虑对心脏性猝死进行一级预防、植入式心脏复律除颤器和抗凝治疗以预防中风。
