Kanbayashi Keigo, Minami Yuichiro, Haruki Shintaro, Saito Chihiro, Yamaguchi Junichi
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
J Cardiol. 2025 Apr;85(4):309-314. doi: 10.1016/j.jjcc.2024.09.003. Epub 2024 Sep 10.
Although diastolic dysfunction is the main pathophysiological feature of hypertrophic cardiomyopathy (HCM), it remains to be clarified whether parameters of diastolic function can reliably determine HCM prognosis. In patients with reduced left ventricular (LV) distensibility, chronic elevation of LV diastolic pressure is seen with a smaller than expected LV size. Accordingly, patients with HCM with severe LV diastolic dysfunction typically demonstrate left atrial (LA) dilation and a disproportionately smaller left ventricle. Therefore, we investigated the relationship between LA/LV diameter ratio, as a potential indicator of disease progression, and outcomes in patients with HCM.
We included 468 patients in whom LA and LV end-diastolic diameter were successfully evaluated by echocardiography at the initial assessment. We divided the patients into two groups: those with an LA/LV diameter ratio > 1 and those with an LA/LV diameter ratio ≤ 1. We compared the HCM-related death rates between the two groups.
Of the 468 patients, 96 patients (20.5 %) with HCM showed an LA/LV diameter ratio > 1. In the univariate analysis, patients with an LA/LV diameter ratio > 1 had a significantly greater likelihood of HCM-related death than patients with an LA/LV diameter ratio ≤ 1 (log-rank p = 0.002). In the multivariate Cox proportional hazards analysis, when including LA/LV diameter ratio > 1 and imbalanced baseline variables, an LA/LV diameter ratio > 1 was an independent determinant of HCM-related death (adjusted hazard ratio: 1.87, 95 % confidence interval: 1.08-3.24; p = 0.024).
LA/LV diameter ratio can be easily evaluated and may be useful for risk stratification of HCM-related death in patients with HCM.
尽管舒张功能障碍是肥厚型心肌病（HCM）的主要病理生理特征，但舒张功能参数能否可靠地确定HCM的预后仍有待阐明。在左心室（LV）扩张性降低的患者中，LV舒张压长期升高，LV大小小于预期。因此，严重LV舒张功能障碍的HCM患者通常表现为左心房（LA）扩张和不成比例的较小左心室。因此，我们研究了作为疾病进展潜在指标的LA/LV直径比与HCM患者预后之间的关系。
我们纳入了468例在初始评估时通过超声心动图成功评估LA和LV舒张末期直径的患者。我们将患者分为两组：LA/LV直径比>1的患者和LA/LV直径比≤1的患者。我们比较了两组之间与HCM相关的死亡率。
在468例患者中，96例（20.5%）HCM患者的LA/LV直径比>1。在单变量分析中，LA/LV直径比>1的患者与HCM相关死亡的可能性显著高于LA/LV直径比≤1的患者（对数秩检验p=0.002）。在多变量Cox比例风险分析中，当纳入LA/LV直径比>1和不平衡的基线变量时，LA/LV直径比>是与HCM相关死亡的独立决定因素（调整后的风险比：1.87，95%置信区间：1.08-3.24；p=0.024）。
LA/LV直径比易于评估，可能有助于对HCM患者的HCM相关死亡进行风险分层。
