Left ventricular chamber dilatation in hypertrophic cardiomyopathy: related variables and prognosis in patients with medical and surgical therapy.
Left ventricular chamber dilatation in hypertrophic cardiomyopathy: related variables and prognosis in patients with medical and surgical therapy.
复制标题
肥厚型心肌病左心室扩张：药物和手术治疗患者的相关变量和预后。
作者：
Christian Seiler;Rolf Jenni;Giuseppe Vassalli;Marko Turina;Otto M. Hess
背景--通过对139例肥厚型心肌病患者的长期随访，确定其左室扩张和收缩功能障碍的发生率和预后。方法：超声心动图测定左心室腔扩大和收缩功能障碍（两者统称为左心室腔扩大）。心腔扩张定义为左心室舒张末期直径每年增加> 2%，同时随访期间心室中部收缩期缩短分数每年减少> 2%[10.3（SD 6）年]。评估临床、侵入性和超声心动图变量对左室腔扩大的预测价值及其预后。结果：139例患者中有119例（86%）的左心室大小和收缩功能保持稳定（第1组），20/139例患者（14%）在随访期间发生左心室扩张（第2组）。在基线检查时，第1组的呼吸困难和晕厥等症状发生率低于第2组;第1组的纽约心脏协会分级低于第2组（P = 0.001）。左心室质量指数相对于性别特异性正常值在组1中增加了18%，在组2中增加了41%（P = 0.04）。第1组的累积生存率略高于第2组，但不显著。第1组的无事件生存率显著高于第2组（P < 0.05）。结论：（1）肥厚型心肌病患者左室扩张和收缩功能障碍的发生率约为每年1.5%。(2)与左心室扩张相关的因素有呼吸困难、晕厥、较高的心功能分级和较高程度的左心室肥大。(3)有心腔扩张的患者预后比无心腔扩张的患者差，特别是在生活质量方面。
BACKGROUND--To determine the incidence and prognosis of left ventricular dilatation and systolic dysfunction in 139 patients with hypertrophic cardiomyopathy during long term follow up. METHODS--Left ventricular chamber dilatation and systolic dysfunction (both together referred to as left ventricular chamber dilatation) were determined echocardiographically. Chamber dilatation was defined as an increase in the left ventricular end diastolic diameter of > 2% per year combined with a decrease in midventricular systolic fractional shortening of > 2% per year of follow up [10.3 (SD 6) years]. The predictive value for left ventricular chamber dilatation of clinical, invasive, and echocardiographic variables and its prognosis were assessed. RESULTS--In 119 of 139 individuals (86%), left ventricular chamber size and systolic function remained stable (group 1), and in 20/139 patients (14%) left ventricular chamber dilatation occurred during follow up (group 2). At baseline examination, symptoms such as dyspnoea and syncope occurred less often in group 1 than in group 2; New York Heart Association classification was lower in group 1 than in group 2 (P = 0.001). Left ventricular mass index relative to sex specific normal values was increased by 18% in group 1 and by 41% in group 2 (P = 0.04). Cumulative survival rates were slightly although not significantly higher in group 1 than in group 2. Event-free survival was significantly higher in group 1 than in group 2 (P < 0.05). CONCLUSIONS--(1) The development of left ventricular chamber dilatation and systolic dysfunction in hypertrophic cardiomyopathy occurs in approximately 1.5% of the patients per year. (2) Factors associated with left ventricular dilatation are dyspnoea, syncope, a higher functional classification, and a higher degree of left ventricular hypertrophy. (3) Patients with chamber dilatation have a worse prognosis than those without, particularly regarding quality of life.