Zhang Jinwei, Cui Hao, Sun Peng, He Jiqiang, Shi Shutian, Kang Yunpeng, Yu Jianbo, Ren Changwei
Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vascular Diseases, Beijing, China.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vascular Diseases, Beijing, China.
Perfusion. 2025 May;40(4):886-892. doi: 10.1177/02676591241262613. Epub 2024 Jun 18.
BackgroundCoronary artery disease and left ventricular outflow tract obstruction may overlap in symptoms in patients with hypertrophic cardiomyopathy. It has not been clear if coronary revascularization relieves exertional symptoms in patients with hypertrophic cardiomyopathy.MethodsWe reviewed 156 patients with hypertrophic cardiomyopathy who underwent percutaneous coronary intervention at Anzhen Hospital from 2009 to 2019. Improvement in symptoms after the percutaneous coronary intervention was investigated.ResultsThe mean age was 60.8 ± 9.8 years, and 116 (74.4%) were men. The main symptoms of the patients were chest tightness in 115 (73.7%), chest pain in 88 (56.4%), dyspnea in 50 (32.1%), palpitation in 22 (14.1%), and presyncope/syncope in 12 (7.7%). At rest, the systolic anterior motion of the mitral valve was observed in only 36 patients. Among the 156 patients, 64 had single-vessel disease, 46 had two-vessel diseases, and the other 46 had three-vessel diseases. There was no early mortality in the present cohort. After the coronary intervention, there were significant improvements in symptoms including chest tightness (6.4%), chest pain (1.3%), dyspnea (2.6%), and palpitation (8.3%). In 93 patients with follow-up data, the overall survival was 77% at 10 years and the survival free from intervention was 60% at 10 years.ConclusionsIn patients with hypertrophic cardiomyopathy, coronary artery disease can be an important cause of symptoms and should be screened. Percutaneous coronary intervention is safe and effective for coronary revascularization. Cardiac symptoms can be significantly relieved and long-term outcomes are favorable.
背景
肥厚型心肌病患者中，冠状动脉疾病与左心室流出道梗阻的症状可能重叠。目前尚不清楚冠状动脉血运重建能否缓解肥厚型心肌病患者的劳力性症状。
方法
我们回顾了2009年至2019年在安贞医院接受经皮冠状动脉介入治疗的156例肥厚型心肌病患者。研究了经皮冠状动脉介入治疗后症状的改善情况。
结果
患者的平均年龄为60.8±9.8岁，男性116例（74.4%）。患者的主要症状为胸闷115例（73.7%）、胸痛88例（56.4%）、呼吸困难50例（32.1%）、心悸22例（14.1%）、先兆晕厥/晕厥12例（7.7%）。静息时，仅36例患者观察到二尖瓣收缩期前向运动。156例患者中，单支血管病变64例，双支血管病变46例，其余46例为三支血管病变。本队列中无早期死亡病例。冠状动脉介入治疗后，胸闷（6.4%）、胸痛（1.3%）、呼吸困难（2.6%）和心悸（8.3%）等症状有显著改善。在93例有随访数据的患者中，10年总生存率为77%，10年无干预生存率为60%。
结论
在肥厚型心肌病患者中，冠状动脉疾病可能是症状的重要原因，应进行筛查。经皮冠状动脉介入治疗对冠状动脉血运重建安全有效。心脏症状可得到显著缓解，长期预后良好。
