肥厚型心肌病患者心源性猝死风险的年龄和性别差异：一项多中心队列研究
Age and Sex Differences in the Risk of Sudden Cardiac Death in Patients with Hypertrophic Cardiomyopathy: A Multi-Centre Cohort Study.
作者信息
Ma Huihui, Xu Fengcheng, Liu Lei, Pan Caixia, Luo Rong, Liu Mingjiang, Liu Tianhu, Shu Yan, Li Xiaoping
机构信息
School of Medicine, University of Electronic Science and Technology of China, Institute of Cardiovascular Diseases & Department of Cardiology, Sichuan Provincial People's Hospital, Chengdu, 610072, People's Republic of China.
Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, People's Republic of China.
出版信息
Vasc Health Risk Manag. 2025 Apr 21;21:251-267. doi: 10.2147/VHRM.S511689. eCollection 2025.
OBJECTIVE
There is a significant difference in prognosis among patients with hypertrophic cardiomyopathy (HCM) across different age groups and gender groups. This study aims to explore the risk of sudden cardiac death (SCD) in various age groups and genders.
METHODS
A cohort of 2781 patients with HCM, initially evaluated between 1996 and 2023, were followed for a median of 4.54 years. The patients were divided into three age groups: youth group (aged ≤ 40 years), middle-aged group (aged between 40 and 60 years), and elderly group (aged ≥60 years). The outcome event was (SCD). Kaplan-Meier survival curves and Cox regression analysis were employed to compare outcomes across different age groups for both genders. Additionally, restricted cubic splines (RCS) were utilized to evaluate the potential relationship between age and prognosis within different gender categories.
RESULTS
A total of 128 patients (4.6%) experienced SCD. In the whole population, significant age differences were observed in the Kaplan-Meier survival curves for SCD (log-rank P<0.0001). Significant age differences in SCD were also noted in both genders (log-rank P<0.0001). In multivariate Cox regression analysis, age was an independent predictor of SCD in the whole population [HR: 0.983; 95% CI: 0.972-0.994; P=0.003] and female patients [HR: 0.963; 95% CI: 0.947-0.98; P<0.001]. However, it was not significant in male patients [HR: 0.995; 95% CI: 0.98-1.01; P=0.538].
CONCLUSION
In patients with HCM, age was an independent predictor of SCD both the whole population and female patients. Compared to young patients, the risk of SCD is reduced by 71.4% in middle-aged patients and by 43.5% in elderly patients across the whole population. Among male patients, the risk of SCD decreases by 68.5% in middle-aged patients and by 10.7% in elderly patients. In female patients, the risk of SCD is reduced by 77.8% in middle-aged patients and by 75.3% in elderly patients.
目的
肥厚型心肌病（HCM）患者在不同年龄组和性别组中的预后存在显著差异。本研究旨在探讨不同年龄组和性别的心脏性猝死（SCD）风险。
方法
对2781例HCM患者进行队列研究，这些患者于1996年至2023年期间首次接受评估，中位随访时间为4.54年。患者被分为三个年龄组：青年组（年龄≤40岁）、中年组（年龄在40至60岁之间）和老年组（年龄≥60岁）。结局事件为SCD。采用Kaplan-Meier生存曲线和Cox回归分析比较不同年龄组和性别的结局。此外，使用受限立方样条（RCS）评估不同性别类别中年龄与预后之间的潜在关系。
结果
共有128例患者（4.6%）发生SCD。在总体人群中，SCD的Kaplan-Meier生存曲线存在显著年龄差异（对数秩检验P<0.0001）。在两个性别中，SCD也存在显著年龄差异（对数秩检验P<0.0001）。在多因素Cox回归分析中，年龄是总体人群[SCD风险比（HR）：0.983；95%置信区间（CI）：0.972-0.994；P=0.003]和女性患者[SCD风险比（HR）：0.963；95%置信区间（CI）：0.947-0.98；P<0.001]中SCD的独立预测因素。然而，在男性患者中不显著[SCD风险比（HR）：0.995；95%置信区间（CI）：0.98-1.01；P=0.538]。
结论
在HCM患者中，年龄是总体人群和女性患者中SCD的独立预测因素。在总体人群中，与年轻患者相比，中年患者SCD风险降低71.4%，老年患者降低43.5%。在男性患者中，中年患者SCD风险降低68.5%，老年患者降低10.7%。在女性患者中，中年患者SCD风险降低77.8%，老年患者降低75.3%。
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