肥厚型心肌病患者冠状动脉微循环功能的评价及初步分析  

Evaluation of Coronary Microcirculatory Function in Patients With Hypertrophic Cardiomyopathy and Analysis of Preliminary Results

作　　者：许浩博 朱法胜 杨伟宪[1] 袁建松[1] 王娟[1] 王天杰[1] 刘一陆 王勇[1] 田涛[1] 乔树宾[1] XU Haobo;ZHU Fasheng;YANG Weixian;YUAN Jiansong;WANG Juan;WANG Tianjie;LIU Yilu;WANG Yong;TIAN Tao;QIAO Shubin(Coronary Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,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,冠心病中心,北京100037

出　　处：《中国循环杂志》2024年第10期983-988,共6页Chinese Circulation Journal

摘　　要：目的:评价肥厚型心肌病患者冠状动脉微循环功能并对结果进行初步分析。方法:前瞻性分析中国医学科学院阜外医院2021年11月至2023年4月间,诊断为肥厚型心肌病且应用压力/温度导丝法测量冠状动脉微循环阻力指数(IMR)的25例患者。以IMR≥25 U定义为冠状动脉微循环功能障碍(CMD),根据是否合并CMD将患者分CMD组(n=15)和非CMD组(n=10),并比较两组患者间的临床特征。结果:25例患者,平均年龄(58.4±13.3)岁,男性18例,平均体重指数(26.7±3.6)kg/m~2。所有患者均检测成功,无检测相关并发症,平均IMR为(30.5±15.3)U。共有15例患者合并CMD。CMD组和非CMD组患者在基线临床特征、实验室检查及用药方面差异均无统计学意义(P均>0.05)。CMD组患者左心室壁最厚处厚度显著大于非CMD组[(20.2±2.8)mm vs.(16.9±2.3)mm,P=0.005],两组在其他超声心动图参数方面差异均无统计学意义(P均>0.05)。在IMR<50 U的22例患者中,左心室壁最厚处厚度与IMR呈显著线性正相关(r=0.423,P=0.049)。两组患者冠状动脉血流储备和血流储备分数方面差异均无统计学意义(P均>0.05)。结论:肥厚型心肌病患者中的CMD严重程度与左心室壁厚度呈正相关。Objectives:To evaluate the coronary microcirculatory function in patients with hypertrophic cardiomyopathy(HCM).Methods:Patients who diagnosed with HCM and underwent the measurement of index of microcirculatory resistance(IMR)using pressure-sensing guide wire from November 2021 to April 2023 were prospectively included.Coronary microcirculatory dysfunction(CMD)was defined as IMR≥25 U and patients were grouped accordingly to compare the clinical characteristics.Results:A total of 25 HCM patients were included.Mean age was(58.4±13.3)years,18 were men and mean body mass index was(26.7±3.6)kg/m2.Coronary microcirculatory function was successfully evaluated in all patients and the mean value of IMR was(30.5±15.3)U.There were 15 patients with CMD.Baseline clinical characteristics,laboratory examinations and medications were simialr between patients with and without CMD.The maximal left ventricular wall was significant thicker in patients with CMD compared with that in patients without CMD([20.2±2.8]mm vs.[16.9±2.3]mm,P=0.005).There was no significant difference in other echocardiographic parameters between two groups(all P>0.05).In the range of IMR value less than 50 U(n=22),there was a significant linear positive correlation between maximal left ventricular wall thickness and IMR(r=0.423,P=0.049).There was no significant difference in coronary flow reserve and fractional flow reserve between two groups.Conclusions:The severity of CMD is positively correlated with left ventricular wall thickness in HCM patients.

关 键 词：肥厚型心肌病 冠状动脉微循环功能障碍 微循环阻力指数 

分 类 号：R54[医药卫生—心血管疾病]