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一名糖尿病合并心尖肥厚型心肌病患者难治性心绞痛的病例报告。

A case report of refractory angina in a patient with diabetes and apical hypertrophic cardiomyopathy.

作者信息

Jex Nicholas, Chowdhary Amrit, Thirunavukarasu Sharmaine, Levelt Eylem

机构信息

Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Woodhouse, Leeds LS2 9JT, UK.

出版信息

Eur Heart J Case Rep. 2022 Aug 16;6(8):ytac347. doi: 10.1093/ehjcr/ytac347. eCollection 2022 Aug.

DOI:10.1093/ehjcr/ytac347
PMID:36045647
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9425848/
Abstract

BACKGROUND

Using serial imaging over time, this case reviews the natural history of co-morbid Type two diabetes (T2D) and apical hypertrophic cardiomyopathy (HCM) and assesses the potential combined impact on myocardial structure and perfusion.

CASE SUMMARY

A 59-year-old patient with concomitant T2D and an apical phenotype of HCM was seen over a 11-year period with a significant burden of anginal chest pain. Chest pain was refractory to anti-anginal medical therapy and persisted at on-going follow-up. Multi-modality imaging demonstrated significant deterioration in coronary microvascular function and increased myocardial scar burden despite unobstructed epicardial coronary arteries.

DISCUSSION

Comorbidity with T2D and apical HCM resulted in a significant increase in myocardial fibrosis and deterioration in coronary microvascular function.

摘要

背景

通过长期的系列成像，本病例回顾了合并2型糖尿病（T2D）和心尖肥厚型心肌病（HCM）的自然病史，并评估了对心肌结构和灌注的潜在综合影响。

病例摘要

一名59岁同时患有T2D和HCM心尖表型的患者，在11年期间出现了严重的心绞痛负担。抗心绞痛药物治疗对胸痛无效，且在持续随访中仍持续存在。多模态成像显示，尽管心外膜冠状动脉未阻塞，但冠状动脉微血管功能显著恶化，心肌瘢痕负担增加。

讨论

合并T2D和心尖HCM导致心肌纤维化显著增加，冠状动脉微血管功能恶化。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/86b0/9425848/e48d99042c2b/ytac347f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/86b0/9425848/4acf4f3531d1/ytac347f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/86b0/9425848/99353db71048/ytac347f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/86b0/9425848/1cdc83e1b776/ytac347f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/86b0/9425848/e48d99042c2b/ytac347f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/86b0/9425848/4acf4f3531d1/ytac347f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/86b0/9425848/99353db71048/ytac347f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/86b0/9425848/1cdc83e1b776/ytac347f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/86b0/9425848/e48d99042c2b/ytac347f4.jpg

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本文引用的文献

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Circulation. 2020 Apr 21;141(16):1282-1291. doi: 10.1161/CIRCULATIONAHA.119.044666. Epub 2020 Feb 14.
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Distinct Subgroups in Hypertrophic Cardiomyopathy in the NHLBI HCM Registry.肥厚型心肌病 NHLBI 登记处的不同亚组。
J Am Coll Cardiol. 2019 Nov 12;74(19):2333-2345. doi: 10.1016/j.jacc.2019.08.1057.
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The impact of diabetes mellitus on the clinical phenotype of hypertrophic cardiomyopathy.
糖尿病对肥厚型心肌病临床表型的影响。
Eur Heart J. 2019 Jun 1;40(21):1671-1677. doi: 10.1093/eurheartj/ehy625.
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Survival and prognostic factors in hypertrophic cardiomyopathy: a meta-analysis.肥厚型心肌病的生存和预后因素：荟萃分析。
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