Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy
Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy
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DOI：
10.1056/nejmoa021332
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发表时间：
2003-01-23
影响因子：
158.5
通讯作者：
Maron, BJ
中科院分区：
文献类型：
--
作者：
Maron, MS;Olivotto, I;Maron, BJ
背景：左心室流出道梗阻对肥厚型心肌病临床预后的影响尚未得到解决。方法我们评估了一大群肥厚型心肌病患者在平均(+/-SD)6.3+/-6.2年的随访中，流出道梗阻对发病率和死亡率的影响。结果在连续的1101例患者中，273例(25%)在基础(静息)条件下出现左室流出道梗阻，瞬时峰值梯度至少为30 mm Hg。共有127名患者(12%)死于肥厚性心肌病，216名幸存患者(20%)有严重的进行性心力衰竭(纽约心脏协会[NYHA]功能III级或IV级)的致残症状。在有流出道梗阻的患者中，肥厚型心肌病相关死亡的总体概率显著高于无梗阻的患者(相对危险度，2.0；P=0.001)。在梗阻患者中，进展到NYHA III或IV级或特别是死于心力衰竭或中风的风险也更大(相对风险，4.4；P
BACKGROUNDThe influence of left ventricular outflow tract obstruction on the clinical outcome of hypertrophic cardiomyopathy remains unresolved.METHODSWe assessed the effect of outflow tract obstruction on morbidity and mortality in a large cohort of patients with hypertrophic cardiomyopathy who were followed for a mean (+/-SD) of 6.3+/-6.2 years.RESULTSOf the 1101 consecutive patients, 273 (25 percent) had obstruction of left ventricular outflow under basal (resting) conditions with a peak instantaneous gradient of at least 30 mm Hg. A total of 127 patients (12 percent) died of hypertrophic cardiomyopathy, and 216 surviving patients (20 percent) had severe, disabling symptoms of progressive heart failure (New York Heart Association [NYHA] functional class III or IV). The overall probability of death related to hypertrophic cardiomyopathy was significantly greater among patients with outflow tract obstruction than among those without obstruction (relative risk, 2.0; P=0.001). The risk of progression to NYHA class III or IV or death specifically from heart failure or stroke was also greater among patients with obstruction (relative risk, 4.4; P