Myocardial bridging, a frequent component of the hypertrophic cardiomyopathy phenotype, lacks systematic association with sudden cardiac death
Myocardial bridging, a frequent component of the hypertrophic cardiomyopathy phenotype, lacks systematic association with sudden cardiac death
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DOI：
10.1093/eurheartj/ehp121
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发表时间：
2009-07-01
影响因子：
39.3
通讯作者：
Maron, Barry J.
中科院分区：
文献类型：
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作者：
Basso, Cristina;Thiene, Gaetano;Maron, Barry J.
左前降支心肌桥在肥厚型心肌病(HCM)中的临床意义仍然存在争议。我们对255例肥厚型心肌病(HCM)患者和140例对照进行了冠状动脉桥的发生率和深度的评估，其中肥厚型心肌病115例(中位数29岁，范围5-90岁；男性占75%)。冠脉桥在肥厚型心肌病中的发生率(41%)高于死于各种非肥厚型心肌病相关原因的患者(21/100；21%；P=0.002)或先天性主动脉瓣狭窄伴左室肥厚的患者(5/40；12%；P=0.001)。77例猝死患者中33例(43%)、27例心力衰竭死亡(或心脏移植)患者中10例(37%)、11例其他死亡方式患者中4例(36%)出现CBS(P=0.826)。合并猝死(21/77，27%)或心力衰竭死亡(5/27，13%；P=0.191)的肥厚型心肌梗死患者中，深埋伏性心动过速(>；=2 mm)的发生率相似。在猝死患者中，CB的出现与性别(女性33%，男性45%，P=0.406)和年龄(41%；18岁vs.44%；18岁；P=0.827)无关。在这250多个心脏的形态分析中，CB是表型表达的HCM的一个常见成分，并且比其他有或没有左室肥厚的疾病更常见。虽然与HCM相关的猝死没有明显的系统性关联，但我们的发现不排除CB可能导致某些个体患者的风险增加，潜在地影响个案基础上的管理决策。
The clinical significance attributable to myocardial bridging of left anterior descending coronary artery in hypertrophic cardiomyopathy (HCM) remains controversial.Prevalence and depth of coronary artery bridges (CBs) were assessed in 255 hearts, including 115 with HCM (median age 29, range 5-90; 75% male), and 140 controls. Coronary artery bridges were more common in HCM (47/115; 41%) than in patients who died of a variety of non-HCM-related causes (21/100; 21%; P = 0.002), or in patients with congenital aortic stenosis and left ventricular (LV) hypertrophy (5/40; 12%; P = 0.001). Among the HCM hearts, CBs were present in 33 of 77 patients (43%) with sudden death, in 10 of 27 (37%) with heart failure death (or heart transplantation), and in 4 of 11 (36%) with other modes of death (P = 0.826). Deeply embedded CBs (>= 2 mm) occurred with similar frequency in HCM patients with sudden (21 of 77; 27%) or heart failure death (5 of 27; 13%; P = 0.191). In sudden death patients, the presence of CB was unrelated to gender (33% in women and 45% in men, P = 0.406) and age (41% < 18 years vs. 44% >= 18 years; P = 0.827).In this morphological analysis of more than 250 hearts, CBs are a frequent component of phenotypically expressed HCM, and more common than in other disorders with or without LV hypertrophy. Although no systematic association with HCM-related sudden death is evident, our findings do not exclude the possibility that CB could contribute to increased risk in some individual patients, potentially impacting management decision-making on a case-by-case basis.