冠状动脉迂曲在老年心尖肥厚型心肌病患者中的发生率及预后指导价值分析  

Analysis of incidence and prognostic value of coronary artery tortuosity in elderly patients with apical hypertrophic cardiomyopathy

作　　者：李文涛[1] 黄一 李晓冰 王山 林青 高传玉[1] LI Wen-tao;HUANG Yi;LI Xiao-bing;WANG Shan;LIN Qing;GAO Chuan-yu(Department of Cardiology,Zhengzhou University Fuwai Central China Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou 450003,China;Information Technology Centre,Zhengzhou University Fuwai Central China Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou 450003,China;Henan Institute of Cardiovascular Epidemiology,Zhengzhou University Fuwai Central China Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou 450003,China;Department of Radiology,Zhengzhou University Fuwai Central China Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学华中阜外医院阜外华中心血管病医院心内科,河南省郑州市450003 [2]郑州大学华中阜外医院阜外华中心血管病医院信息中心,河南省郑州市450003 [3]郑州大学华中阜外医院河南省心血管流行病学中心,河南省郑州市450003 [4]郑州大学华中阜外医院阜外华中心血管病医院放射科,河南省郑州市450003

出　　处：《中国心血管病研究》2024年第9期789-794,共6页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨冠状动脉迂曲在心尖肥厚型心肌病(AHCM)患者中的发生率,分析冠状动脉迂曲与该类患者不良预后相关性。方法 连续入取2018年7月至2021年12月在阜外华中心血管病医院就诊的心尖肥厚型心肌病患者43例为AHCM组,根据性别、年龄、高血压配对非肥厚型心肌病患者作为对照组,对比两组患者临床基线特点、超声心动图和冠状动脉造影结果,电话+病历随访患者至2023年12月30日,主要终点是恶性心律失常、缺血性卒中、全因死亡的复合结局,复合终点是主要终点+全因再住院的复合结局,比较两组发病密度,Cox风险比例模型探讨AHCM患者的危险因素。结果 经过匹配,两组患者平均年龄(65.7±4.9)岁,最小年龄均>60岁,但AHCM组患者LVEF和左心室最大厚度显著高于对照组(P均<0.05),其中AHCM组心尖厚度中位数为20 mm。AHCM组冠状动脉迂曲发生率显著高于对照组(81.4%比41.9%,P<0.001),冠状动脉迂曲评分也显著高于对照组(P<0.001)。经过3.1年随访,AHCM组复合终点发病密度显著高于对照组(27.4/人年比5.9/人年,RR=2.06,95%CI 1.35~3.14,P<0.001),而冠状动脉迂曲评分(HR=1.10,95%CI 0.88~1.38,P=0.385)并非AHCM患者复合终点不良危险因素。结论 老年AHCM患者易伴发冠状动脉迂曲,且程度更重;冠状动脉迂曲并非老年AHCM患者不良事件的危险因素。Objective To investigate the incidence and prognostic value of coronary artery tortuosity in patients with apical hypertrophic cardiomyopathy(AHCM).Methods 43 patients with AHCM admitted to the Henan Provincial People's Hospital from July 2018 to December 2021 were consecutively enrolled as AHCM group,and the patients with non-hypertrophic cardiomyopathy paired according to gender,age and hypertension were used as controls.The clinical baseline characteristics,echocardiographic and coronary angiographic findings were compared between the two groups,and patients were followed up by telephone and medical record until December 30,2023;the primary endpoint was the composite outcome of malignant arrhythmia,ischemic stroke and all-cause death,and the composite endpoint was the composite outcome of primary endpoint+all-cause rehospitalization.The incidence density of the two groups were compared,and Cox risk proportional models were used to explore the risk factors in patients with AHCM.Results After matching,the mean age of two groups was(65.7±4.9)and a minimum age>60 years in the both groups,but the LVEF and maximum LV thickness were significantly larger in the AHCM patients than in the control group(P<0.05 for both),with an apical thickness of 20 mm in the AHCM group.The incidence of coronary artery tortuosity was significantly higher in the AHCM group than in the control group(81.4%vs.41.9%,P<0.001),and the score of coronary artery tortuosity was also significantly higher than in the control group(P<0.001).After 3.1 years of follow-up,the composite endpoint incidence density was significantly higher in the AHCM group than in the control group(27.4 per person vs.5.9 per person-year,RR=2.06,95%CI 1.35-3.14,P<0.001),whereas the score of coronary artery tortuosity(HR=1.10,95%CI 0.88-1.38,P=0.385)was not an adverse risk factor for the composite endpoint in AHCM patients.Conclusion Elderly patients with AHCM are prone to coronary tortuosity even to a greater extent;Coronary tortuosity is not a risk factor for adverse eve

关 键 词：心尖肥厚型心肌病 冠状动脉迂曲 老年 

分 类 号：R542.2[医药卫生—心血管疾病]