左室心肌致密化不全患者的冠状动脉病变特点及其预后分析  

Incidence of coronary artery disease and outcome of patients with left ventricular noncompaction

作　　者：高晓津[1] 康连鸣[1] 张健[1] 江勇[2] 赵世华[3] 陆敏杰[3] 程怀兵[3] 罗晓亮[1] 蒋文[1] 吕蓉 祝捷[1] 杨跃进[1] 

机构地区：[1]北京协和医学院中国医学科学院阜外心血管病医院心内科,100037 [2]北京协和医学院中国医学科学院阜外心血管病医院超声科,100037 [3]北京协和医学院中国医学科学院阜外心血管病医院放射科,100037

出　　处：《中华心血管病杂志》2011年第8期725-729,共5页Chinese Journal of Cardiology

基　　金：北京市科委重大项目（D0906004040291）

摘　　要：目的总结左室心肌致密化不全（LVNC）患者的冠状动脉病变特点，并对LVNC预后的影响因素进行分析。方法连续入选自2006年1月至2010年8月经超声心动图和（或）心脏磁共振成像确诊为LYNC并进行了冠状动脉造影或多排螺旋CT（MDCT）检查的患者共51例，总结其冠状动脉病变特点，并分析冠状动脉病变对LVNC预后的影响。结果20例（39．22％）患者合并冠心病，其中单支病变9例，双支病变3例，三支病变5例，合并左主干病变3例；4例行冠状动脉旁路移植术（CABG）和（或）经皮冠状动脉介入治疗（PCI）。合并冠心病组（20例）与非冠心病组（31例）比较，前者平均年龄及合并糖尿病、高血压病、高脂血症的比例均高于后者（P〈0．05）；前者氨基末端B型利钠肽前体（NT-proBNP）水平低于后者（中位数：1078．3pmol／L比1211．0pmol／L）；两组之间的心原性死亡和（或）心脏移植事件及心原性再住院的发生率差异无统计学意义；logNT-proBNP是LVNC预后的独立危险因素（HR=3．993，95％CI：1．140～13．988，P=0．030）。结论应当对LVNC患者常规进行冠状动脉检查；NT—proBNP是LVNC预后的独立危险因素；合并冠心病对LVNC预后没有显著影响。Objective To analyze the incidence of coronary artery disease （CAD） and outcome of patients with left ventricular noncompaction （LVNC）. Methods Fifty-one patients with LVNC evaluated by echocardiography and/or cardiac magnetic resonance （CMR） from January 2006 to August 2010 were retrospectively reviewed. Coronary angiography or MDCT was performed for detecting coronary artery disease. Predictors of the cardiac events were analyzed by Cox regression analysis. Results There were 31 LVNC patients without CAD and 20 LVNC patients with CAD including single vessel coronary disease in 9 cases, double vessel coronary disease in 3 cases, three vessel coronary disease in 5 cases and left main coronary disease in 3 cases. Coronary artery bypass graft and pereutaneous coronary intervention （PCI） were performed in 4 patients. Compared to LVNC patients without CAD, mean age （P = 0. 008） , incidence of hypertension （65.0% vs. 19.4% , P = 0. 001 ）, diabetes mellitus （40. 0% vs. 12. 9% ,P = 0. 026） and hyperlipidemia （ 55.0% vs. 25.8% , P = 0. 035 ） were significantly higher while NT-proBNP level was significantly lower（ P = 0. 049 ）in LVNC patients with CAD. Incidence of major cardiac events was similar in LVNC patients with or without CAD. LogNT-proBNP is the independent prognostic factor for adverse cardiac events in patients with LVNC （HR 3. 993,95 % CI 1. 140-13. 988, P = 0. 030）. Conclusions Coronary artery disease is common in patients with LVNC and associated with traditional risk factors for CAD. Poor prognosis is associated with increased NT-proBNP but not with CAD in this patient cohort.

关 键 词：心肌疾病 冠状动脉疾病 利钠肽 脑 预后 

分 类 号：R541[医药卫生—心血管疾病]