超声引导下经皮心肌内室间隔射频消融术治疗梗阻性肥厚型心肌病对Lown分级的影响  

Effect of echocardiography-guided percutaneous intramyocardial septal radiofrequency ablation on the Lown classification in patients with hypertrophic obstructive cardiomyopathy

作　　者：李莹 拓胜军 王静 李静 欧绪梅 梁常婷 雷常慧 刘佳妮 姚璐 刘丽文 Li Ying;Ta Shengjun;Wang Jing;Li Jing;Ou Xumei;Liang Changting;Lei Changhui;Liu Jiani;Yao Lu;Liu Liwen(Department of Ultrasound,the First Affiliated Hospital of Air Force Medical University(Xi'jing Hospital),Hypertrophic Cardiom yopathy International Cooperation Center,the First Affiliated Hospital of Air Force Medical University(Xi'jing Hospital),Multidisciplinary Consultation Center of Hypertrophic Cardiomyopathy,Shaanxi Province,Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy,Xi'jing 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4期288-294,共7页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(82071932);军队装备重点课题(KJ20191A050284);陕西省重点研发计划(2022KW-32);空军军医大学临床研究资助计划(2021XD010);空军军医大学凌云计划人才扶持计划(2020lyjhllw);西京医院学科助推计划(XJZT18Z03);西京医院科技发展基金(YYKJFZJJ2018Y002)。

摘　　要：目的探讨超声引导下经皮心肌内室间隔射频消融术(PIMSRA)治疗梗阻性肥厚型心肌病(HOCM)对室性心律失常Lown分级的影响。方法回顾性纳入2017年5月至2019年10月在空军军医大学西京医院接受PIMSRA治疗的HOCM患者85例。所有患者分别在术前和术后1年行24 h动态心电图检查,获取Lown分级参数,比较手术前后Lown分级的变化。根据Lown分级是否显著改善将患者分为改善组和未改善组,比较两组间相关资料的差异。分析Lown分级改善的影响因素。结果与术前比较,术后Lown分级有显著改善(P=0.001),其中LownⅠ级例数显著增加(P=0.001),Ⅲ级例数显著减少(P=0.005),Lown 0级、Ⅱ级以及Ⅳ级例数无显著变化(均P>0.05)。改善组伴有肥厚型心肌病(HCM)家族史的比例、基线Lown分级、最大左室壁厚度减薄率和左心室流出道激发压差降低率高于未改善组(均P<0.05)。多因素Logistic回归分析显示,HCM家族史(OR=3.95,95%CI=1.34~11.64,P=0.013)、基线Lown分级(OR=2.01,95%CI=1.25~3.22,P=0.004)和左心室流出道激发压差降低率(OR=1.02,95%CI=1.00~1.04,P=0.041)为术后Lown分级改善的独立影响因素。结论PIMSRA后HOCM患者Lown分级明显改善,HCM家族史、基线Lown分级和术后左心室流出道激发压差降低率是Lown分级改善的独立影响因素。Objective To investigate the effect of percutaneous intramyocardial septal radiofrequency ablation(PIMSRA)guided by echocardiography on the Lown classification of ventricular arrhythmias in patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods A total of 85 patients with HOCM who received PIMSRA treatment at Xijing Hospital of Air Force Military Medical University from May 2017 to October 2019 were retrospectively selected.All patients underwent 24-hour Holter examinations before and 1 year after PIMSRA to obtain parameters related to Lown classification.The changes in Lown grades after PIMSRA were analyzed.The patients were divided into improved group and unimproved group according to whether there was significant improvement in Lowen's grades,and the difference of the parameters related were compared.The influencing factors of the changes in Lown classification were analyzed.Results Compared with before PIMSRA,there was a significant improvement in the Lown classification after PIMSRA(P=0.001).The patients with Lown grade I increased significantly(P=0.001),and the patients with grade II decreased significantly(P=0.005).There were no significant changes in patients with Lown grades O,II,and IV(all P>0.05).The proportion of patients with family history of hypertrophic cardiomyopathy(HCM),the baseline Lown classes,the reduction rate of the maximum left ventricular wall thickness and the reduction rate of the provocative left ventricular outflow tract gradient(LVOTG)were higher in the improved group than the unimproved group(all P<0.05).Multivariate Logistic regression results showed that HCM family history(OR=3.95,95%CI=1.34-11.64,P=0.013),baseline Lown classes(OR=2.01,95%CI=1.25-3.22,P=0.004)and the reduction rate of the provocative LVOTG gradient(OR=1.02,95%CI=1.00-1.04,P=0.041)were independent factors of postoperative Lown classification improvement.Conclusions The Lown classes of HOCM patients after PIMSRA is significantly improved.HCM family history,the baseline Lown classes,and the reduction ra

关 键 词：心肌病 肥厚性 经皮心肌内室间隔射频消融术 LOWN分级 

分 类 号：R542.2[医药卫生—心血管疾病]