中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
6期
783-787
,共5页
心肌致密化不全%超声心动图%心力衰竭%心肌病
心肌緻密化不全%超聲心動圖%心力衰竭%心肌病
심기치밀화불전%초성심동도%심력쇠갈%심기병
Non-compaction of ventricular myocardium%Echocardiography%Heart failure%Cardiomyopathy
目的 观察心肌致密化不全(NVM)患者的临床特点、超声心动图特征和预后.方法 对2010-2012年在北京安贞医院住院确诊的101例NVM患者的临床症状、超声心动图、预后进行统计,随访主要不良事件包括心律失常、血栓栓塞、心功能恶化.分析临床特点和超声心动图数据对终点事件(死亡和心脏移植)的预测价值.结果 101例NVM患者中67例(66.3％)男性,34例(33.7％)女性,年龄0～79岁,平均(29 ±25)岁.11例患者(10.9％)≥60岁,其中≥70岁的患者有4例(4.0％).出现症状至确诊年限2.12(0.53 ～6.98)年,无症状者8例(8.0％),气促69例(68.3％),胸痛19例(18.8％),晕厥4例(4.0％),脑血管事件1例(1.0％),纽约心脏病学会(NYHA)心功能分级Ⅰ级14例(13.9％)、Ⅱ级37例(36.6％)、Ⅲ级31例(30.7％)、Ⅳ级19例(18.8％).3例患者(3.0％)有心脏病家族史,4例患者(4.0％)至少有一名亲属有类似病变.57例患者(56.4％)出现充血性心力衰竭,9例患者(8.9％)合并扩张性心肌病.47例患者的首发症状是心力衰竭;14例首发症状是心律失常.56.4％的患者(57/101)左心室射血分数(LVEF)＜30％,22.8％的患者(23/101) LVEF≥50％,随访(2.6±1.4)年.严重并发症有:重度心力衰竭27例(26.7％)、心脏移植6例(6.0％),室性心律失常16例(15.8％),血栓事件3例(3.0％),死亡33例(32.7％).死亡和心脏移植的相关因素有心功能不全NYHAⅢ级或Ⅳ级(风险比=3.98,P=0.04)、LVEF减低(风险比=0.89,P=0.006)、因心力衰竭加重住院(风险比=13.29,P＜0.001).结论 ①心力衰竭患者在行超声心动图检查时初次发现NVM;②超声心动图检查经常诊断过度;③确诊NVM患者发生心脏移植、死亡不良事件风险大,需要严密随访.
目的 觀察心肌緻密化不全(NVM)患者的臨床特點、超聲心動圖特徵和預後.方法 對2010-2012年在北京安貞醫院住院確診的101例NVM患者的臨床癥狀、超聲心動圖、預後進行統計,隨訪主要不良事件包括心律失常、血栓栓塞、心功能噁化.分析臨床特點和超聲心動圖數據對終點事件(死亡和心髒移植)的預測價值.結果 101例NVM患者中67例(66.3％)男性,34例(33.7％)女性,年齡0～79歲,平均(29 ±25)歲.11例患者(10.9％)≥60歲,其中≥70歲的患者有4例(4.0％).齣現癥狀至確診年限2.12(0.53 ～6.98)年,無癥狀者8例(8.0％),氣促69例(68.3％),胸痛19例(18.8％),暈厥4例(4.0％),腦血管事件1例(1.0％),紐約心髒病學會(NYHA)心功能分級Ⅰ級14例(13.9％)、Ⅱ級37例(36.6％)、Ⅲ級31例(30.7％)、Ⅳ級19例(18.8％).3例患者(3.0％)有心髒病傢族史,4例患者(4.0％)至少有一名親屬有類似病變.57例患者(56.4％)齣現充血性心力衰竭,9例患者(8.9％)閤併擴張性心肌病.47例患者的首髮癥狀是心力衰竭;14例首髮癥狀是心律失常.56.4％的患者(57/101)左心室射血分數(LVEF)＜30％,22.8％的患者(23/101) LVEF≥50％,隨訪(2.6±1.4)年.嚴重併髮癥有:重度心力衰竭27例(26.7％)、心髒移植6例(6.0％),室性心律失常16例(15.8％),血栓事件3例(3.0％),死亡33例(32.7％).死亡和心髒移植的相關因素有心功能不全NYHAⅢ級或Ⅳ級(風險比=3.98,P=0.04)、LVEF減低(風險比=0.89,P=0.006)、因心力衰竭加重住院(風險比=13.29,P＜0.001).結論 ①心力衰竭患者在行超聲心動圖檢查時初次髮現NVM;②超聲心動圖檢查經常診斷過度;③確診NVM患者髮生心髒移植、死亡不良事件風險大,需要嚴密隨訪.
목적 관찰심기치밀화불전(NVM)환자적림상특점、초성심동도특정화예후.방법 대2010-2012년재북경안정의원주원학진적101례NVM환자적림상증상、초성심동도、예후진행통계,수방주요불량사건포괄심률실상、혈전전새、심공능악화.분석림상특점화초성심동도수거대종점사건(사망화심장이식)적예측개치.결과 101례NVM환자중67례(66.3％)남성,34례(33.7％)녀성,년령0～79세,평균(29 ±25)세.11례환자(10.9％)≥60세,기중≥70세적환자유4례(4.0％).출현증상지학진년한2.12(0.53 ～6.98)년,무증상자8례(8.0％),기촉69례(68.3％),흉통19례(18.8％),훈궐4례(4.0％),뇌혈관사건1례(1.0％),뉴약심장병학회(NYHA)심공능분급Ⅰ급14례(13.9％)、Ⅱ급37례(36.6％)、Ⅲ급31례(30.7％)、Ⅳ급19례(18.8％).3례환자(3.0％)유심장병가족사,4례환자(4.0％)지소유일명친속유유사병변.57례환자(56.4％)출현충혈성심력쇠갈,9례환자(8.9％)합병확장성심기병.47례환자적수발증상시심력쇠갈;14례수발증상시심률실상.56.4％적환자(57/101)좌심실사혈분수(LVEF)＜30％,22.8％적환자(23/101) LVEF≥50％,수방(2.6±1.4)년.엄중병발증유:중도심력쇠갈27례(26.7％)、심장이식6례(6.0％),실성심률실상16례(15.8％),혈전사건3례(3.0％),사망33례(32.7％).사망화심장이식적상관인소유심공능불전NYHAⅢ급혹Ⅳ급(풍험비=3.98,P=0.04)、LVEF감저(풍험비=0.89,P=0.006)、인심력쇠갈가중주원(풍험비=13.29,P＜0.001).결론 ①심력쇠갈환자재행초성심동도검사시초차발현NVM;②초성심동도검사경상진단과도;③학진NVM환자발생심장이식、사망불량사건풍험대,수요엄밀수방.
Objective To describe the clinical,echocardiographic and prognostic features of non-compaction of ventricular myocardium (NVM).Methods Between 2010 and 2012,101 suspected cases of NVM were identified in Beijing Anzhen Hospital.The diagnosis of NVM was confirmed in 101 cases by echocardiographic evaluation in Anzhen Hospital echocardiography department.The main adverse events were arrhythmias,thromboembolism and heart function.Death or heart transplantation was the main endpoint of our study.Results The patients included 67 men (66.3％) and 34 women(33.7％),aged 0-79 (29 ±25) years.11 (10.9％) patients were 60 years or more at the time of echocardiography and 4 cases(4.0％) were more than 70 years.There were 8 cases(8.0％),shortness of breath 69 cases(68.3％),19 chest pain cases(18.8％),4 syncope cases(4.0％),cerebrovascular event 1 case(1.0％),New York heart association(NYHA) class Ⅰ 14 cases(13.9％) ; class Ⅱ 37cases(36.6％) ; class Ⅲ 31 cases(30.7％) ; class Ⅳ 19 cases(18.8％).A family history of cardiac disease was present in 3 cases (3.0％).Congestive heart failure was in 57 patients (56.4％),dilated cardiomyopathy was in 9 cases(8.9％).Left NVM was detected with heart failure symptoms in 47 patients and rhythm disorders in 14 patients.Left ventricular ejection fraction (LVEF) was ＜ 30％ in 56.4％ and LVEF≥50％ was in 22.8％.During (2.6 ± 1.4) years of follow-up,several complications occurred,including severe heart failure in 27 cases (26.7％),heart transplantation in 6 cases (6.0％),ventricular arrhythmia in 16 cases (15.8％),embolic events in 3 cases(3.0％),and death in 33 cases (32.7％).Factors that associated with death or heart transplantation were NYHA Ⅲ or Ⅳ[hazard ratio(HR) =3.98,P=0.04],LVEF decreased (HR =0.89,P =0.006)and hospitalization for heart failure (HR =13.29,P ＜ 0.001).Conclusion ①NVM is detected by screening echocardiography in heart failure patients.②NVM is frequently over-diagnosed by echocardiography.③Patients identified as NVM have a high risk of severe complications,transplantation or death.
