运动血流动力学检测对预测肥厚型心肌病预后的价值  

Value of exercise hemodynamics in predicting prognosis of hypertrophic cardiomyopathy

作　　者：魏俊俊 王先涛 栾献亭 Wei Junjun;Wang Xiantao;Luan Xianting(Department of Cardiology,Fifth People's Hospital of Pingdingshan City,Pingdingshan 467000,China.;不详)

机构地区：[1]平顶山市第五人民医院心内科,平顶山467000 [2]平顶山市第二人民医院心内科,平顶山467000

出　　处：《中国循证心血管医学杂志》2023年第2期218-220,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探究肥厚型心肌病(HCM)合并异常血压反应(ABPR)患者的临床特征,明确ABPR是否与左心室流出道梗阻(LVOTO)及不良预后相关。方法回顾性纳入2014~2018年间于平顶山市第二人民医院心内科就诊并接受心肺运动试验的HCM患者103例,其中ABPR组患者27例,对照组76例;分析ABPR组患者临床特征、恶性心律失常及心力衰竭(心衰)相关事件资料,并比较两组患者出院后生存情况。结果与对照组相比,ABPR组运动试验中包括预测最大摄氧量[(65.05±16.80)%vs.(81.47±12.48)%,P<0.05]和代谢当量[(5.39±1.44)vs.(8.20±3.34),P<0.05]等心肺功能指标显著降低,左心室流出道压差更高[(43.22±24.52)mmHg vs.(31.11±17.12)mmHg,P<0.05],但LVOTO例数方面无显著差异(62.96%vs.44.74%,P>0.05)。患者出院后平均随访4.37±1.31年,ABPR与恶性心律失常事件风险无显著相关(P=0.536),但与心衰相关事件风险的显著提升相关(P=0.028)。ABPR组中,是否存在LVOTO与不良事件风险无关。结论无论是否存在LVOTO,ABPR与心脏储备能力下降有关,且ABPR患者发生心衰相关事件风险更高。Objective To investigate the clinical characteristics in patients with hypertrophic cardiomyopathy(HCM)complicated by abnormal blood pressure response(ABPR),and to clarify the correlation among ABPR,left ventricular outflow tract obstruction(LVOTO)and poor prognosis.Methods HCM patients(n=103)were retrospectively chosen from the Second People’s Hospital of Pingdingshan City from 2014 to 2018,and divide into ABPR group(n=27)and control group(n=76).The relevant materials of clinical characteristics,malignant arrhythmia and events related to heart failure(HF)were analyzed in ABPR group.The survival situation after discharged was compared between 2 groups.Results The indexes of cardiopulmonary function decreased significantly,including predicted maximal oxygen uptake VO2max,[(65.05±16.80)%vs.(81.47±12.48)%,P<0.05]and metabolic equivalent MET[(5.39±1.44)vs.(8.20±3.34),P<0.05],left ventricular outflow tract gradient LVOTG[(43.22±24.52)mmHg vs.(31.11±17.12)mmHg,P<0.05]increased,but number of LVOTO cases had no significant difference(62.96%vs.44.74%,P>0.05)in ABPR group compared with control group.The patients were averagely followed up for(4.37±1.31)y after discharged.ABPR was not(correlated to risk of malignant arrhythmia(P=0.536),but correlated to the risk increases of HF-related events(P=0.028).The incidence of LVOTO was not correlated to adverse events in ABPR group.Conclusion ABPR is related to the decrease of cardiac reserve capability,and the risk of HF-related events is higher in ABPR patients whether LVOTO incidence or not.

关 键 词：肥厚型心肌病 血压 临床特征 左心室流出道梗阻 预后 

分 类 号：R542.2[医药卫生—心血管疾病]