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Circulation:肥厚性心肌病伴左室收缩功能障碍的发生、发展及预后

2020-05-04 QQY MedSci原创

“终末期”常被用于描述肥厚性心肌病(HCM)伴左室收缩功能障碍(LVSD),定义为左室射血分数<50%。据报道,HCM-LVSD预后较差,但由于其相对罕见,其自然史仍未完

“终末期”常被用于描述肥厚性心肌病(HCM)伴左室收缩功能障碍(LVSD),定义为左室射血分数<50%。据报道,HCM-LVSD预后较差,但由于其相对罕见,其自然史仍未完全明确。

本研究通过对来自11个不同中心的数据进行分析来归纳HCM-LVSD的特征。

一个包含6793位HCM患者的队列中,有553位(8%)患者符合HCM-LVSD标准。总体上,75%的HCM-LVSD患者会经历临床相关事件,35%的患者发生复合结局(全因死亡[128例]、心脏移植[55例]、左心室辅助设备植入[9例])。在确诊HCM-LVSD后,发生复合结局的中位时间为8.4年。但有大量的患者的情况迥然不同。复合结局的重要预测因素包括存在多种致病性/可能致病性肉瘤变异(HR 5.6)、房颤(2.6)和左室射血分数<35%(2.0)。15年间,HCM-LVSD的发生率约为7.5%。发生HCM-LVSD的重要预测因素包括基线评估时左心室容积变大(HR 1.1)和室壁变薄(1.3)、左室射血分数 50%-60%(1.8),以及心脏MRI晚期信号增强(2.3)、致病性/可能致病性肉瘤变异(1.5),特别是细丝基因变异(2.5)。

大约8%的HCM患者被确诊为HCM-LVSD。虽然HCM-LVSD的自然史可变,但在发生收缩功能障碍后中位时间约为8.4年后,75%的患者都经历过不良事件。除了临床特征外,遗传因素(多种肉瘤变异)似乎也在HCM-LVSD发生风险和预后中发挥作用。

原始出处:

Peter Marstrand,et al. Hypertrophic Cardiomyopathy With Left Ventricular Systolic Dysfunction. Circulation. 2020;141:1371–1383

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