Pelliccia F, Seggewiss H, Cecchi F, Calabrò P, Limongelli G, Alfieri O, Ferrazzi P, Yacoub M H, Olivotto I
Department of Cardiovascular Sciences, University Sapienza, Via del Policlinico 155, 00161, Rome, Italy.
Comprehensive Heart Failure Center (CHFC), Deutsches Zentrum Für Herzinsuffizienz (DZHI), Universitätsklinikum Würzburg, Würzburg, Germany.
Curr Cardiol Rep. 2021 Oct 1;23(11):165. doi: 10.1007/s11886-021-01600-5.
Patients with hypertrophic cardiomyopathy (HCM) who have left ventricular outflow tract obstruction (LVOTO) often experience severe symptoms and functional limitation. Relief of LVOTO can be achieved by two invasive interventions, i.e., surgery myectomy and alcohol septal ablation (ASA), leading in experienced hands to a dramatic improvement in clinical status. Despite extensive research, however, the choice of the best option in individual patients remains challenging and poses numerous clinical dilemmas.
Invasive strategies have been recently incorporated in recommendations for the diagnosis and treatment of HCM on both sides of the Atlantic. These guidelines are based on a bulk of well-designed but retrospective studies as well as on expert opinions. Evidence now exists that adequate evaluation and management of HCM requires a multidisciplinary team capable of choosing the best available options. Management of LVOTO still varies largely based on local expertise and patient preference. Following the trend that has emerged for other cardiac diseases amenable to invasive interventions, the concept of a "HCM heart team" is coming of age.
患有肥厚型心肌病（HCM）且伴有左心室流出道梗阻（LVOTO）的患者常常出现严重症状和功能受限。可通过两种侵入性干预措施缓解LVOTO，即外科室间隔心肌切除术和酒精室间隔消融术（ASA），在经验丰富的医生操作下可使临床状况显著改善。然而，尽管进行了广泛研究，但在个体患者中选择最佳治疗方案仍具有挑战性，并带来诸多临床难题。
最近，侵入性治疗策略已被纳入大西洋两岸HCM诊断和治疗的推荐意见中。这些指南基于大量精心设计但为回顾性的研究以及专家意见。现在有证据表明，对HCM进行充分评估和管理需要一个能够选择最佳可用方案的多学科团队。LVOTO的治疗仍因地区专业水平和患者偏好而存在很大差异。随着适用于侵入性干预的其他心脏病所出现的趋势，“HCM心脏团队”的概念正在逐渐成熟。
