Department of Cardiology, Matsushita Memorial Hospital.
Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine.
Circ J. 2023 Jul 25;87(8):1068-1074. doi: 10.1253/circj.CJ-23-0131. Epub 2023 Jun 7.
Patients with hypertrophic cardiomyopathy (HCM) show various physical findings, but their clinical significance has not been systematically evaluated.
This study evaluated 105 consecutive patients with HCM who had undergone phonocardiography and external pulse recording. Physical examinations included a visible jugular a-wave (Jug-a), audible 4th sound (S4), and double or sustained apex beat. The primary outcome was a composite of all-cause death and hospitalization for cardiovascular disease. A total of 104 non-HCM subjects served as controls. The prevalence of visible Jug-a in the seated or supine position, audible S4, and a sustained or double apex beat in patients with HCM were 10%, 71%, 70%, 42%, and 27%, respectively, all of which were significantly higher than in the controls (0%, 20%, 11%, 17%, and 2%; P<0.001 for all comparisons). The combination of visible Jug-a in the supine position and audible S4 yielded a specificity of 94% and sensitivity of 57%. During a follow-up period of 6.6 years, 6 patients died and 10 were hospitalized. The absence of audible S4 was a predictor of cardiovascular events (hazard ratio, 3.91; 95% confidence interval, 1.41 to 10.8; P=0.005).
Detection of these findings has clinical importance in the diagnosis and risk stratification of HCM prior to the use of advanced imaging techniques.
肥厚型心肌病（HCM）患者表现出各种体格检查结果，但这些结果的临床意义尚未得到系统评估。
本研究评估了 105 例连续接受心音图和外部脉搏记录的 HCM 患者。体格检查包括可见颈静脉 a 波（Jug-a）、可闻 4 心音（S4）、双重或持续心尖搏动。主要终点是全因死亡和心血管疾病住院的复合终点。104 例非 HCM 患者作为对照。HCM 患者中仰卧或坐姿可见 Jug-a、可闻 S4、持续或双重心尖搏动的发生率分别为 10%、71%、70%、42%和 27%，均显著高于对照组（0%、20%、11%、17%和 2%；所有比较 P<0.001）。仰卧位可见 Jug-a 与可闻 S4 联合检测的特异性为 94%，敏感性为 57%。在 6.6 年的随访期间，有 6 例患者死亡，10 例患者住院。无可闻 S4 是心血管事件的预测因子（风险比，3.91；95%置信区间，1.41 至 10.8；P=0.005）。
在使用先进的成像技术之前，这些发现对于 HCM 的诊断和风险分层具有临床重要意义。
