LONG-TERM OUTCOME OF PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY SUCCESSFULLY RESUSCITATED AFTER CARDIAC-ARREST
LONG-TERM OUTCOME OF PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY SUCCESSFULLY RESUSCITATED AFTER CARDIAC-ARREST
复制标题
DOI：
10.1016/0735-1097(89)90302-1
复制
发表时间：
1989-05-01
影响因子：
24
通讯作者：
EPSTEIN, SE
中科院分区：
文献类型：
--
作者：
CECCHI, F;MARON, BJ;EPSTEIN, SE
这项研究描述了 33 名肥厚型心肌病患者的长期结果，这些患者经历了心脏骤停但成功复苏。心脏骤停发生在 9 岁至 62 岁之间（平均 32 岁）；五名患者在多次（两次或三次）逮捕中幸存。进行了多种治疗； 18例左心室流出道梗阻患者行室间隔肌切开术或二尖瓣置换术并接受药物治疗； 15名患者接受了单独的药物治疗。迄今为止，33 名患者中有 22 名 (67%) 在初次心脏骤停后存活了 17 个月至 22 年（平均 7 年）； 12 名患者在 .gtoreq 中幸存。 5 和 6 为 .gtoreq。年。在 22 名幸存者中，有 16 人在随访期间保持无症状或仅有轻微症状；另外 6 人出现严重心力衰竭症状，其中 3 人有左心室壁变薄和腔扩大的证据。 8 名患者最终在初次心脏骤停后 7 个月至 8.4 年（平均 4 年）内因自然心脏原因（突然或进行性心力衰竭）死亡。精算患者生存率为 97.+-。 3%, 74 .+-. 9% 和 61 .+-. 1 年、5 年和 10 年后分别为 11%。无事件发生率（定义为没有复发性心脏骤停或死亡的精算生存率）为 83 .+-。 7%, 65 .+-. 9% 和 53 .+-.分别为 11%。对于这组肥厚型心肌病患者来说，他们接受了多种治疗策略的非系统性治疗，心脏骤停后的长期结果各不相同。三分之一的患者出现复发性心脏骤停或心源性过早死亡（突然或由于充血衰竭），最常见于初次心脏骤停后的前 5 年内。相反，大多数患者都幸存下来，并且通常没有出现明显的症状，并且没有出现随后的心脏骤停；因此，在肥厚型心肌病中，猝死的中止发作并不一定会带来一致的不祥预后，并且在某些患者中，猝死似乎是其疾病自然史中的孤立和意外事件。
This study describes the long-term outcome of 33 patients with hypertrophic cardiomyopathy who experienced a cardiac arrest but were successfully resuscitated. Cardiac arrest occurred at ages 9 to 62 years (mean 32); five patients survived multiple (two or three) arrests. A variety of treatments were administered; 18 patients with left ventricular outflow tract obstruction underwent ventricular septal myotomy-myectomy or mitral valve replacement and also received drug therapy; 15 patients received medical therapy alone. To date, 22 (67%) of the 33 patients have survived after the initial cardiac arrest for periods of 17 months to 22 years (mean 7 years); 12 patients have survived for .gtoreq. 5 and 6 for .gtoreq. years. Of the 22 survivors, 16 have remained asymptomatic or only mildly symptomatic over the period of follow-up; 6 others have become severely symptomatic with heart failure, including 3 with evidence of left ventricular wall thinning and cavity enlargement. Eight patients ultimately died of natural cardiac causes (suddenly or of progressive heart failure) 7 months to 8.4 years (mean 4 years) after their initial cardiac arrest. Actuarial patient survival was 97 .+-. 3%, 74 .+-. 9% and 61 .+-. 11% after 1, 5 and 10 years, respectively. Event-free rate (defined as actuarial survival without recurrent cardiac arrest or death) was 83 .+-. 7%, 65 .+-. 9% and 53 .+-. 11%, respectively. For this group of patients with hypertrophic cardiomyopathy who were treated in a nonsystematic fashion with a variety of therapeutic strategies, the long-term outcome after surviving a cardiac arrest was variable. Recurrent cardiac arrest or premature cardiac death (sudden or due to congestive failure) occurred in one-third of the patients, most commonly within the first 5 years after the initial arrest. Conversely, most patients have survived and remained free of subsequent cardiac arrest usually without experiencing marked symptoms; hence, aborted episodes of sudden death do not necessarily convey a uniformly ominous prognosis in hypertrophic cardiomyopathy and in some patients appear to be isolated and unexpected events in the natural history of their disease.