Ishihara Kakeru, Kubota Yoshiaki, Matsuda Junya, Imori Yoichi, Tokita Yukichi, Asai Kuniya, Takano Hitoshi
Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-0022, Japan.
J Clin Med. 2023 Aug 5;12(15):5137. doi: 10.3390/jcm12155137.
Patients with hypertrophic cardiomyopathy (HCM) may progress to the dilated phase (DHCM). This study aimed to identify the predictive factors for DHCM progression, including left ventricular (LV) ejection fraction (LVEF < 50%) or decreased LV contraction (LVEF < 60%). The study included 291 patients enrolled in our hospital's HCM registry who were grouped based on their poststudy LVEF (LVEF of ≥60%, 50-59%, and <50%). Predictive factors of an LVEF of <50% or <60% were determined. Further, the effects of percutaneous transluminal septal myocardial ablation (PTSMA) on long-term systolic LV function and DHCM development were investigated. LVEF was ≥60%, 50-59%, and <50% in 239, 33, and 19 patients, respectively, during the follow-up period (mean: 64.9 months). Multivariate analyses indicated baseline atrial fibrillation (AF), nonsustained ventricular tachycardia (NSVT), and left ventricular diameter at end-systole (LVDs) as significant predictors of DHCM. Using a scoring method based on AF, NSVT, and LVDs, patients with 2 and 3 points had a significantly higher risk of developing DHCM. PTSMA in 78 HCM patients demonstrated no significant effect on long-term LVEF changes or DHCM development. We concluded that AF, NSVT, and LVDs are significant predictors of DHCM development. However, a validation study with a larger population is required.
肥厚型心肌病（HCM）患者可能会进展到扩张期（DHCM）。本研究旨在确定DHCM进展的预测因素，包括左心室（LV）射血分数（LVEF<50%）或左心室收缩功能降低（LVEF<60%）。该研究纳入了291例登记在我院HCM注册系统中的患者，这些患者根据研究后的LVEF（LVEF≥60%、50-59%和<50%）进行分组。确定了LVEF<50%或<60%的预测因素。此外，还研究了经皮腔内室间隔心肌消融术（PTSMA）对左心室长期收缩功能和DHCM发展的影响。随访期间，LVEF≥60%、50-59%和<50%的患者分别为239例、33例和19例（平均：64.9个月）。多因素分析表明，基线房颤（AF）、非持续性室性心动过速（NSVT）和收缩末期左心室直径（LVDs）是DHCM的重要预测因素。使用基于AF、NSVT和LVDs的评分方法，得2分和3分的患者发生DHCM的风险显著更高。78例HCM患者接受PTSMA治疗后，长期LVEF变化或DHCM发展无显著影响。我们得出结论，AF、NSVT和LVDs是DHCM发展的重要预测因素。然而，需要进行更大规模人群的验证研究。
