肥厚型梗阻性心肌病合并二尖瓣瓣环钙化的危险因素和预后价值分析  

Risk factors and prognostic value of mitral annulus calcification in obstructive hypertrophic cardiomyopathy patients undergone septal myectomy

作　　者：吴子宁 朱昌盛[1] 聂长荣 蒙延海[2] 杨秋蓝[2] 刘小希[1] 王水云[1] WU Zi-ning;ZHU Chang-sheng;NIE Chang-rong;MENG Yan-hai;YANG Qiu-lan;LIU Xiao-xi;WANG Shui-yun(Department of Cardiac Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Intensive Care Unit,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院、国家心血管病中心阜外医院成人外科中心,北京市100037 [2]中国医学科学院北京协和医学院、国家心血管病中心阜外医院重症监护室,北京市100037

出　　处：《中国心血管病研究》2023年第4期352-358,共7页Chinese Journal of Cardiovascular Research

摘　　要：目的 明确二尖瓣瓣环钙化(MAC)在肥厚性梗阻型心肌病(HOCM)手术患者中的发生率,并分析其危险因素及对患者的预后价值。方法 回顾性收集2016年至2021年就诊于阜外医院并接受室间隔肌切除术的HOCM患者连续队列,根据MAC及严重程度分组并比较组间基线及预后差异。生存数据通过Kaplan-Meier法比较。通过logistic回归确定术前发生MAC的危险因素。Cox多因素回归用于分析评估MAC对终点事件的影响。结果 整个队列共纳入1035例患者,112例(10.82%)患者存在MAC。多因素logistic回归显示,女性、高龄、主动脉瓣环钙化、主动脉钙化、二尖瓣收缩前向运动(SAM)、二尖瓣瓣叶增厚和术前三尖瓣反流是MAC的危险因素。术后全因死亡(3.57%比1.08%,P=0.031)、主要不良心脑血管事件(MACCE)(23.21%比14.41%,P=0.015)、复发中度以上二尖瓣反流(8.04%比2.49%,P=0.001)和纽约心功能分级Ⅲ~Ⅳ级心力衰竭(心衰)(11.61%比5.53%,P=0.012)在合并MAC的患者中更为常见。在调整其他心血管相关危险因素后,MAC是术后复发中度以上二尖瓣反流的独立危险因素(HR=2.47)。中重度MAC是远期MACCE事件的独立危险因素(HR=1.93)。结论 HOCM患者发生MAC主要与高龄、女性、其他部位钙化、基线二尖瓣及三尖瓣状态等相关。在改良扩大室间隔肌切除术后,合并MAC的HOCM患者预后较差,二尖瓣反流复发率更高。Objective To explore the incidence of mitral annulus calcification(MAC)in patients with hypertrophic obstructive cardiomyopathy(HOCM)undergone septal myectomy,and to analyze its risk factors and prognostic value for the patients.Methods Consecutive HOCM patients who underwent septal myectomy in Fuwai Hospital from 2016 to 2021 were collected and compared according to the existence of MAC and its severity in preoperative CT scans.The survival data were evaluated and compared by Kaplan-Meier analysis.The risk factors for preoperative MAC were determined through logistic regression.Cox multivariate regression was used to analyze and evaluate the impact of MAC on endpoint events.Results Among 1035 patients,112(10.82%)had MAC.Multivariate regression showed that female,age,aortic annular calcification,aortic calcification,systolic anterior motion of the mitral valve(SAM),mitral valve thickening,and tricuspid regurgitation were the independent predictors of MAC.All-cause mortality(3.57%vs.1.08%,P=0.031),major adverse cardiovascular and cerebrovascular events(MACCE)(23.21%vs.14.41%,P=0.015),recurrent MR>2+(8.04%vs.2.49%,P=0.001)and NYHA(New York Heart Association)Ⅲ-Ⅳ(11.61%vs.5.53%,P=0.012)were more frequent in HOCM patients with MAC after myectomy.MAC was discovered to be an independent predictor of postoperative recurrent MR>2+after other risk factors taken into account(HR=2.47).Moderate-to-severe MAC was an independent risk factor(HR=1.93)for MACCE.Conclusion The occurrence of MAC in HOCM patients is associated with age,females,calcification in other regions and baseline mitral and tricuspid valve status.HOCM patients with MAC had a worse prognosis and more recurrent mitral valve regurgitation than those without MAC after septal myectomy.

关 键 词：二尖瓣瓣环钙化 肥厚型梗阻性心肌病 室间隔肌切除术 

分 类 号：R542.2[医药卫生—心血管疾病]