RESPONSE TO ISOPROTERENOL AS A PROGNOSTIC INDICATOR OF EVOLUTION FROM HYPERTROPHIC CARDIOMYOPATHY TO A PHASE RESEMBLING DILATED CARDIOMYOPATHY
RESPONSE TO ISOPROTERENOL AS A PROGNOSTIC INDICATOR OF EVOLUTION FROM HYPERTROPHIC CARDIOMYOPATHY TO A PHASE RESEMBLING DILATED CARDIOMYOPATHY
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DOI：
10.1016/0735-1097(94)00432-p
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发表时间：
1995-03-01
影响因子：
24
通讯作者：
SUGISHITA, Y
中科院分区：
文献类型：
--
作者：
KAWANO, S;IIDA, K;SUGISHITA, Y
目标。我们试图评估异丙肾上腺素负荷超声心动图能否提前发现哪些肥厚型心肌病患者进展到类似扩张型心肌病的阶段。据报道，在少数患者中，肥厚型心肌病进展到以收缩功能障碍和左心室扩张为特征的阶段，类似于扩张型心肌病。对18例典型肥厚型心肌病(肥厚、高动力、无扩张型)患者静脉滴注异丙肾上腺素(0.02 mg/kg体重/min)5min前后的超声心动图进行比较，将患者分为反应良好组(收缩分数差7%，14例)和反应差组(差小于或等于7%，4例)。在平均5.4年的随访期内，应用系列超声心动图评价左室舒张末期内径和短轴缩短率的变化。在反应良好组，在随访期内，舒张末内径和短轴缩短率均无明显变化。在反应不良组中，舒张末内径从平均+/-5 mm增加到53+/-5 mm(p<；0.05)，缩短率从40+/-12%显著减少到29+/-10%(p<；0.05)，所有患者的缩短率均显著减少(大于或等于5%)，舒张末内径增加(大于或等于5 mm)。1例患者在观察期内因收缩功能不全而发生充血性心力衰竭。目前的研究证实，典型肥厚型心肌病患者对异丙肾上腺素输注的反应受损与未来左心功能的恶化有关。
Objectives. We sought to assess whether isoproterenol stress echocardiography could detect in advance in which patients hypertrophic cardiomyopathy mould progress to a phase resembling dilated cardiomyopathy.Background. In a few patients, hypertrophic cardiomyopathy has been reported to progress to a phase characterized by systolic dysfunction and left ventricular dilation, resembling dilated cardiomyopathy.Methods. Echocardiograms were recorded before and immediately after intravenous infusion of isoproterenol (0.02 mu g/kg body weight per min) for 5 min in 18 patients with typical hypertrophic cardiomyopathy (i.e., hypertrophied, hyperdynamic and nondilated) to determine the difference in fractional shortening, The patients were categorized into those with a good response (difference in fractional shortening >7%, 14 patients) and those with a poor response (difference less than or equal to 7%, 4 patients). Changes in left ventricular end-diastolic diameter and fractional shortening were evaluated by using serial echocardiography over an average follow-up period of 5.4 years.Results. In the good response group, neither end-diastolic diameter nor fractional shortening changed significantly during the follow-up period. In the poor response group, end-diastolic diameter significantly increased from a mean +/- SD of 41 +/- 5 to 53 +/- 5 mm (p < 0.05), and fractional shortening significantly decreased from 40 +/- 12% to 29 +/- 10% (p < 0.05), All patients in the poor response group showed a substantial decrease (greater than or equal to 5%) in fractional shortening and an increase (greater than or equal to 5 mm) in end-diastolic diameter. One patient developed congestive heart failure due to systolic dysfunction during the observation period.Conclusions. The present study confirmed that impaired responses to isoproterenol infusion are related to future deterioration of left ventricular performance in patients with typical hypertrophic cardiomyopathy.