经皮心肌内室间隔射频消融术治疗轻度室间隔肥厚的梗阻性肥厚型心肌病的随访研究  

A follow-up study of percutaneous intramyocardial septal radiofrequency ablation in the treatment of obstructive hypertrophic cardiomyopathy with mild septal hypertrophy

作　　者：欧绪梅 梁常婷 李莹 雷常慧 王静 拓胜军 姚璐 刘丽文 Ou Xumei;Liang Changting;Li Ying;Lei Changhui;Wang Jing;Ta Shengjun;Yao Lu;Liu Liwen(Department of Ultrasound,the First Affiliated Hospital of Air Force Medical University(Xijing Hospital),Hypertrophic Cardiomyopathy International Cooperation Center,the First Affiliated Hospital of Air Force Medical University(Xijing Hospital),Multidisciplinary Consultation Center of Hypertrophic Cardiomyopathy,Shaanxi Province,Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy,Xijing Hospital,Xi′an 710032,China)

机构地区：[1]空军军医大学第一附属医院(西京医院)超声医学科、空军军医大学第一附属医院(西京医院)肥厚型心肌病国际合作中心、陕西省肥厚型心肌病多学科会诊中心、西京医院肥厚型心肌病多学科诊治与遗传咨询中心,西安710032

出　　处：《中华超声影像学杂志》2023年第2期97-104,共8页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(82071932);军队装备重点课题(KJ20191A05XXXX);陕西省重点研发计划(2022KW-32);西京医院学科助推计划(XJZT18Z03);空军军医大学临床研究资助计划实施方案(2021XD010);空军军医大学凌云计划人才扶持计划(2020lyjhllw);西京医院科技发展基金(YYKJFZJJ2018Y002)。

摘　　要：目的评价经皮心肌内室间隔射频消融术(PIMSRA)治疗轻度室间隔肥厚的梗阻性肥厚型心肌病患者的临床效果。方法纳入2016年11月至2021年2月在空军军医大学西京医院肥厚型心肌病诊治中心接受PIMSRA治疗的轻度室间隔肥厚(最大左室壁厚度15~19 mm)的梗阻性肥厚型心肌病患者45例, 收集其临床资料, 评估术前、术后6个月及术后1年的临床症状、NYHA心功能分级等;采用经胸超声心动图评价术前、术后6个月及术后1年的室间隔厚度、左室流出道内径、左室流出道压差、二尖瓣反流、左室收缩及舒张功能等, 监测并记录术中并发症发生情况;采用常规12导联心电图和24 h动态心电图监测术后心律失常。结果所有患者均成功完成PIMSRA治疗, 术中及围术期内无死亡、出血和卒中等临床不良事件发生, 术后无左束支传导阻滞、完全性房室传导阻滞和恶性心律失常发生, 所有患者均无需永久起搏器植入。与术前相比, 术后6个月的NYHA心功能分级提高, 临床症状显著改善(均P<0.001), 术后1年基本保持稳定。与术前相比, 术后6个月的前间隔厚度、后间隔厚度、最大左室壁厚度减小(均P<0.001);左室流出道内径增宽(P<0.001), 术后1年持续改善;静息和激发左室流出道压差显著降低(均P<0.001);二尖瓣反流量减少, SAM征分级降低(均P<0.001);左室舒张末期内径增加, 左心房内径减小(均P<0.001), 术后1年基本保持稳定;左房容积指数减小(P<0.001), 术后1年持续改善;二尖瓣舒张早期血流速度与二尖瓣环舒张早期速度的比值(E/e′)减小(P=0.001), 术后1年基本保持稳定;左室舒张末期容积、左室收缩末期容积、左室射血分数三组之间差异无统计学意义(均P>0.05)。结论 PIMSRA治疗轻度室间隔肥厚的梗阻性肥厚型心肌病的临床效果良好。Objective To evaluate the clinical efficacy of percutaneous intramyocardial septal radiofrequency ablation(PIMSRA)in the treatment of obstructive hypertrophic cardiomyopathy(HOCM)with mild septal hypertrophy.Methods Forty-five HOCM patients with mild septal hypertrophy(the maximal left ventricular wall thickness is 15-19 mm)who were treated with PIMSRA between November 2016 to February 2021 in the Hypertrophic Cardiomyopathy Center of Xijing Hospital of Air Force Military Medical University were enrolled,and their clinical datas were collected and analyzed.The clinical symptoms and NYHA functional class before operation,6 months and 1 year after operation were collected.Interventricular septum thickness,left ventricular outflow tract pressure gradient,left ventricular outflow tract diameter,mitral regurgitation,left ventricular systolic and diastolic function were evaluated by transthoracic echocardiography before operation,6 months and 1 year after operation,intraoperative complications were monitored and recorded.Postoperative arrhythmias were monitored by routine 12 lead ECG and 24-hour ambulatory ECG.Results All patients successfully completed PIMSRA procedure.No clinical adverse events such as death,bleeding and stroke occurred during and around the operation.No left bundle branch block,complete atrioventricular block and malignant arrhythmia occurred after the operation.All patients did not need permanent pacemaker implantation.NYHA functional class and clinical symptoms of patients were significantly improved after 6 months compared with values before operation(all P<0.001,respectively),it remained stable for 1 year after operation;Anterior interventricular septum,posterior interventricular septum,maximal left ventricular wall thickness all significantly decreased(all P<0.001,respectively),left ventricular outflow tract diameter widened(P<0.001),continuous improvement 1 year after operation;left ventricular outflow tract gradient and provoked left ventricular outflow tract gradient all significantly decrea

关 键 词：超声心动描记术 心肌病 肥厚型 经皮心肌内室间隔射频消融术 治疗结果 

分 类 号：R542.2[医药卫生—心血管疾病]