肥厚型心肌病中的左心室基底部肌束：左心室流出道梗阻机制的新见解。
Left ventricular basal muscle bundle in hypertrophic cardiomyopathy: insights into the mechanism of left ventricular outflow tract obstruction.
机构信息
Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China.
Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China.
出版信息
Eur Heart J Cardiovasc Imaging. 2022 Jul 21;23(8):1018-1026. doi: 10.1093/ehjci/jeab200.
AIMS
Many factors cause left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM). Previous studies reported that left ventricular basal muscle bundle (BMB) may be associated with LVOTO. We aimed to evaluate the role of BMB in LVOTO by echocardiography.
METHODS AND RESULTS
Two hundred fifty-six patients diagnosed with HCM were recruited. The morphologic characteristics of left ventricular outflow tract (LVOT) were analysed. BMB was detected in 178 (69.5%) patients by echocardiography. Patients were separated by a resting or provocative LVOT gradient ≥30 mmHg or not. Compared to patients without LVOTO, patients with LVOTO had a significantly thicker basal septum, elongated anterior mitral leaflet (AML), shorter distance between the AML-free margin and the septum or BMB (M-sept/bundle), larger angle between the plane of the mitral valvular orifice and the ascending aorta (MV-AO angle), and higher prevalence of BMB (P < 0.05). According to multivariate analysis, the independent predictors of LVOTO were the presence of BMB, a large basal septum thickness, a short M-sept/bundle, a large MV-AO angle, and a large AML [odds ratio (95% confidence interval): 5.207 (1.381-19.633), 1.386(1.141-1.683), 0.615(0.499-0.756), 1.113(1.054-1.176), and 1.343(1.076-1.677), respectively, P < 0.05]. Of the 256 included patients, 139 underwent surgical myectomy. The transthoracic echocardiography, compared with surgical specimen, showed: sensitivity 98.3%, specificity 82.3%, positive predictive value 97.6%, negative predictive value 87.5%, and accuracy 96.4% to detect BMB.
CONCLUSIONS
BMB is common in HCM. BMB is a risk factor for LVOTO.
目的
肥厚型心肌病（HCM）患者中存在多种导致左心室流出道梗阻（LVOTO）的因素。既往研究报道左心室基底部肌束（BMB）可能与 LVOTO 相关。本研究旨在通过超声心动图评估 BMB 在 LVOTO 中的作用。
方法和结果
共纳入 256 例诊断为 HCM 的患者。分析左心室流出道（LVOT）的形态特征。超声心动图检测到 178 例（69.5%）患者存在 BMB。根据静息或激发状态下 LVOT 跨壁压梯度≥30mmHg 将患者分为两组。与无 LVOTO 的患者相比，LVOTO 患者的基底部室间隔更厚，二尖瓣前叶（AML）更长，AML 游离缘与室间隔或 BMB（M-sept/bundle）之间的距离更短，二尖瓣瓣口平面与升主动脉之间的夹角（MV-AO 角）更大，BMB 的检出率更高（P<0.05）。多因素分析显示，BMB 的存在、基底部室间隔厚度较大、M-sept/bundle 较短、MV-AO 角较大、AML 较大是 LVOTO 的独立预测因素[比值比（95%置信区间）：5.207（1.381-19.633）、1.386（1.141-1.683）、0.615（0.499-0.756）、1.113（1.054-1.176）和 1.343（1.076-1.677），P<0.05]。在 256 例纳入的患者中，有 139 例行外科心肌切除术。与外科标本比较，经胸超声心动图检测 BMB 的敏感度为 98.3%，特异度为 82.3%，阳性预测值为 97.6%，阴性预测值为 87.5%，准确性为 96.4%。
结论
BMB 在 HCM 中较为常见。BMB 是 LVOTO 的危险因素。
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