Risk factors for sudden cardiac death in hypertrophic cardiomyopathy
Risk factors for sudden cardiac death in hypertrophic cardiomyopathy
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肥厚型心肌病心源性猝死的危险因素
DOI：
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发表时间：
2009
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通讯作者：
G. Parcharidis
中科院分区：
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作者：
G. Efthimiadis;D. Parcharidou;E. Pagourelias;A. Ziakas;E. Mantzari;C. Pliakos;H. Karvounis;I. Styliadis;G. Parcharidis
本研究的目的是评估六种非侵入性临床指标作为肥厚型心肌病（HCM）猝死（SD）的危险因素。在 166 名患者（112 名男性，51.8 ± 15.6 岁）队列中对既往晕厥、SD 家族史、非持续性室性心动过速、运动时血压反应异常、过度肥厚≥3 cm 以及峰值梯度≥30 mmHg 的左心室流出道梗阻进行评估，中位随访时间为 32.4 个月（范围 1 至 209 个月）。在随访期间，13 名患者达到了研究终点：SD、心脏骤停、记录的持续性室性心动过速和/或植入式心脏复律除颤器 (ICD) 放电。经历过晕厥或超声心动图最大壁厚≥3cm的患者对SDemergence更敏感，因为他们的相对风险分别较高13.07（95％CI：4.00-46.95，p <0.0001）和10.07（95％CI：2.92-34.79，p = 0.003）。在我们的患者队列中，六个“公认的”SD 潜在危险因素中只有两个被发现敏感，这一结果引起了对 HCM 患者植入 ICD 预防 SD 的标准有效性的怀疑。
Aim of this study was the evaluation of six non invasive clinical indices as risk factors for sudden death (SD)in hypertrophic cardiomyopathy (HCM). Previous syncope, family history of SD, non sustained ventricular tachycardia, abnormalblood pressure response during exercise, excessive hypertrophy ≥3 cm and left ventricular outflow tract obstructionwith a peak gradient ≥30 mmHg were evaluated in a cohort of 166 patients(112 males, 51.8 ± 15.6 years), followed up for amedian of 32.4 months (range 1 to 209 months). During follow up 13 patients reached study’s endpoints: SD, cardiac arrest,documented sustained ventricular tachycardia and/or Implantable Cardioverter Defibrillator (ICD)-discharge. Patients havingexperienced syncope or presenting with a Maximum Wall Thickness ≥3cm in echocardiography were more sensitive to SDemergence since they had a 13.07 (95%CI: 4.00-46.95, p < 0.0001) and a 10.07 (95%CI: 2.92-34.79, p = 0.003) greater relativerisk respectively. In our cohort of patients only two of the six ‘recognised’ potential risk factors for SD were found sensitive,a result causing scepticism about the validity of criteria used for ICD implantation in HCM patients for SD prevention.