CAJ | 학술논문

目的评估肥厚型心肌病(HCM)患者静息和运动中左室流出道梗阻的情况.方法连续入选的60例静息左室流出道压差(LVOTG) ＜50 mm Hg(1 mm Hg=0.133 kPa)的HCM患者,超声测量静息LVOTG和运动峰值LVOTG.51例静息LVOTG＜ 30 mm Hg的患者中,26例患者运动峰值LVOTG≥30 mm Hg为潜在梗阻,25例运动峰值LVOTG＜ 30 mm Hg为非梗阻.9例静息LVOTG30 ～49 mm Hg为静息梗阻.分析不同类型梗阻的形态学特征.结果潜在梗阻与非梗阻患者相比,二尖瓣前叶收缩期前向运动(SAM)征(73.1％比8.0％)、流出道狭窄(46.2％比4.0％)更常见、二尖瓣反流程度更重、静息LVOTG[(16.9±7.2) mm Hg比(7.1 ±4.3)mm Hg]更高,室间隔肥厚部位分布差异有统计学意义(P值均＜0.05).多因素logistic回归分析,SAM征(OR 6.431,95％ CI2.323 ～291.112,P=0.002)和室间隔肥厚部位(OR0.011,95％ CI0.001 ～0.179,P=0.008)为发生潜在梗阻的独立预测因素.结论约半数静息无梗阻的HCM患者存在潜在梗阻.SAM征和室间隔肥厚部位有助于潜在梗阻的识别.
목적 평고비후형심기병(HCM)환자정식화운동중좌실류출도경조적정황.방법 련속입선적60례정식좌실류출도압차(LVOTG) ＜50 mm Hg(1 mm Hg=0.133 kPa)적HCM환자,초성측량정식LVOTG화운동봉치LVOTG.51례정식LVOTG＜ 30 mm Hg적환자중,26례환자운동봉치LVOTG≥30 mm Hg위잠재경조,25례운동봉치LVOTG＜ 30 mm Hg위비경조.9례정식LVOTG30 ～49 mm Hg위정식경조.분석불동류형경조적형태학특정.결과 잠재경조여비경조환자상비,이첨판전협수축기전향운동(SAM)정(73.1％비8.0％)、류출도협착(46.2％비4.0％)경상견、이첨판반류정도경중、정식LVOTG[(16.9±7.2) mm Hg비(7.1 ±4.3)mm Hg]경고,실간격비후부위분포차이유통계학의의(P치균＜0.05).다인소logistic회귀분석,SAM정(OR 6.431,95％ CI2.323 ～291.112,P=0.002)화실간격비후부위(OR0.011,95％ CI0.001 ～0.179,P=0.008)위발생잠재경조적독립예측인소.결론 약반수정식무경조적HCM환자존재잠재경조.SAM정화실간격비후부위유조우잠재경조적식별.
Objective To assess the condition of left ventricular outflow tract obstruction (LVOTO) under resting conditions and physiological exercise in hypertrophic cardiomyopathy (HCM) patients.Methods A total of 60 patients with HCM and left ventri cular outflow tract gradient (LVOTG) ＜ 50 mm Hg (1 mm Hg =0.133 kPa) at rest were enrolled consecutively,and LVOTG at rest and exercise were measured by echocardiography.Of 51 patients with gradients ＜ 30 mm Hg at rest,26 were latent LVOTO with exercise peak value LVOTG ≥ 30 mm Hg,25 were non LVOTO with exercise peak value LVOTG ＜ 30 mm Hg,and 9 were resting obstruction with LVOTG 30-49 mm Hg.The morphological characteristics of different types of obstruction were analyzed.Results Patients with latent LVOTO were more likely to have SAM(73.1％ vs 8.0％),narrow of LVOT(46.2％ vs 4.0％),higher resting gradients [(16.9 ±7.2) mm Hg vs (7.1 ± 4.3) mm Hg] and mitral regurgitation grade at rest than patients with non-obstructive (all P values ＜ 0.05).The distribution of septal hypertrophy were different in the two groups (P ＜ 0.05).Multivariate logistic regression analysis showed independent predictors of latent LVOTO were SAM (OR 6.431,95 ％ CI 2.323-291.112,P =0.002) at rest and distribution of septal hypertrophy (OR 0.011,95％ CI 0.001-0.179,P =0.008).Conclusions Approximately half of patients with nonobstructive HCM at rest have latent LVOTO.SAM and distribution of septal hypertrophy may be useful to identify patients with latent obstruction.