Kim Eun Kyoung, Hwang Ji-Won, Chang Sung-A, Park Sung-Ji, Kim Ji Hoon, Park Seung Woo, Kim Sung Mok, Choe Yeon Hyeon, Lee Sang-Chol
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Republic of Korea.
Int J Cardiol. 2023 Jan 1;370:287-293. doi: 10.1016/j.ijcard.2022.09.063. Epub 2022 Sep 27.
Data regarding long-term cardiac and cerebrovascular adverse events in patients with hypertrophic cardiomyopathy (HCM) and apical aneurysm (AAn) are scarce and specific treatment strategies that include the use of anticoagulants have not yet been established. We aimed to evaluate the prevalence and long-term prognostic implication based on characteristics of AAn in patients with HCM.
A total of 458 consecutive patients diagnosed with HCM underwent cardiovascular magnetic resonance imaging and echocardiography from August 1, 2008 to December 31, 2015. AAn was classified into Grade 1 and Grade 2 based on size and morphology. The patients were followed up for a median duration of 6.3 years (range, 4.2-8.7 years) for major adverse cardiac and cerebral events (MACCEs); a composite of cardiac death, HCM-related hospitalization, cerebrovascular accident (CVA), heart transplantation, myocardial infarction, and implantable cardiac defibrillator/cardiac resynchronization therapy.
AAn was detected in 9.2%. MACCEs developed more frequently in patients with AAn than in those without AAn (30.1% vs. 20.7%, P = 0.015), with the rate of CVA as the main difference (9.7% vs. 5.3%, P = 0.011). Grade 2 AAn group showed significantly higher MACCE than Grade 1 AAn group (41.8% vs. 21.9%, P < 0.001). In multivariate analysis, the presence of AAn was independently associated with increased risk of MACCEs (adjusted hazard ratio: 1.95; 95% confidence interval, CI: 1.16-3.28; P = 0.012).
AAn is independently associated with increased risk of HCM-related adverse events, especially cerebral infarction, with significant relationship between aneurysm size and adverse events.
关于肥厚型心肌病（HCM）合并心尖部室壁瘤（AAn）患者的长期心脏和脑血管不良事件的数据稀缺，且尚未确立包括使用抗凝剂在内的具体治疗策略。我们旨在根据HCM患者AAn的特征评估其患病率及长期预后意义。
2008年8月1日至2015年12月31日期间，共有458例连续诊断为HCM的患者接受了心血管磁共振成像和超声心动图检查。根据大小和形态将AAn分为1级和2级。对患者进行了为期6.3年（范围4.2 - 8.7年）的主要心脏和脑血管不良事件（MACCEs）随访；MACCEs是心脏死亡、HCM相关住院、脑血管意外（CVA）、心脏移植、心肌梗死以及植入式心脏除颤器/心脏再同步治疗的综合事件。
AAn的检出率为9.2%。有AAn的患者发生MACCEs的频率高于无AAn的患者（30.1%对20.7%，P = 0.015），主要差异在于CVA发生率（9.7%对5.3%，P = 0.011）。2级AAn组的MACCEs显著高于1级AAn组（41.8%对21.9%，P < 0.001）。多因素分析中，AAn的存在与MACCEs风险增加独立相关（校正风险比：1.95；95%置信区间，CI：1.16 - 3.28；P = 0.012）。
AAn与HCM相关不良事件风险增加独立相关，尤其是脑梗死，且动脉瘤大小与不良事件之间存在显著关系。
