新疆医科大学第一附属医院综合心脏内科;新疆和田学院药学院;
目的 研究肥厚型心肌病(HCM)合并肺动脉高压(PH)患者发生不良预后的危险因素。方法 选取确诊为HCM的患者(n=154),根据是否合并PH将患者分为对照组(n=119)与病例组(n=35),并对比分析基线及超声心动图资料；再将病例组患者根据肺动脉收缩压(PASP)升高程度分为PH 1组(n=25)及PH 2组(n=10)。对患者进行随访并记录2年内是否发生不良事件，运用Cox回归分析HCM合并PH的患者发生不良预后的危险因素，绘制KM生存曲线进行HCM合并PH患者生存风险分析。结果 HCM患者的PH患病率22.73%,与对照组相比，女性(48.57%)及合并心律失常(42.86%)的患者在病例组中占比较大(P<0.01)。对病例组患者进行斯皮尔曼相关性分析提示女性、中重度瓣膜反流与PASP的变化正相关，心房内径、左房室耦联指数、左室质量分数及二尖瓣舒张早期血流速度峰值(E)与二尖瓣环根部舒张早期心肌运动速度峰值(e′)(E/e′)值均可随PASP水平的升高而增加(P<0.05),左室射血分数随PASP水平的增加而降低(P<0.001)。HCM患者不良事件发生率为25.97%,Log Rank检验提示PH 1组与PH 2组患者累计生存率组间差异有统计学意义(P<0.001),Cox回归分析提示，PASP(HR=1.123,95%CI:1.033～1.221)及E/e′值(HR=1.131,95%CI:1.054～1.213)均为合并PH的HCM患者2年内发生不良事件的独立危险因素(P<0.05)。结论 PASP水平及E/e′值均为HCM合并PH患者发生不良预后的独立危险因素。
| 104 | 0 | 34 |
| 下载次数 | 被引频次 | 阅读次数 |
[1] Ommen S R,Mital S,Burke M A,et al.2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy:a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines[J].Circulation,2020,142(25):e558-631.doi:10.1161/cir.0000000000000937.
[2] Sugiura K,Kubo T,Ochi Y,et al.Very long-term prognosis in patients with hypertrophic cardiomyopathy:a longitudinal study with a period of 20 years[J].ESC Heart Fail,2022,9(4):2618-25.doi:10.1002/ehf2.13983.
[3] Jin Q,Chen D,Zhang X,et al.Medical management of pulmonary arterial hypertension:current approaches and investigational drugs[J].Pharmaceutics,2023,15(6):1579.doi:10.3390/pharmaceutics15061579.
[4] Writing Committee Members,Ommen S R,Mital S,et al.2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy:a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines[J].J Thorac Cardiovasc Surg,2021,162(1):e23-106.doi:10.1016/j.jtcvs.2021.04.001.
[5] Held M,Wilkens H.Pulmonary hypertension-the new ESC guideline[J].Dtsch Med Wochenschr,2023,148(22):1448-55.doi:10.1055/a-1966-9703.
[6] Santulli G,Wang X,Mone P.Updated ACC/AHA/HFSA 2022 guidelines on heart failure:what is new from epidemiology to clinical management[J].Eur Heart J Cardiovasc Pharmacother,2022,8(5):e23-4.doi:10.1093/ehjcvp/pvac029.
[7] 王华，李莹莹.2022年AHA/ACC/HFSA心力衰竭管理指南解读——从新指南看心衰分类和诊断评估[J].中国心血管病研究，2022,20(6):481-6.doi:10.3969/j.issn.1672-5301.2022.06.001.[7] Wang H,Li Y Y.2022 AHA/ACC/HFSA heart failure management guidelines Interpretations—classification and diagnostic evaluation of heart failure[J].Chin J Cardiovasc Res,2022,20(6):481-6.doi:10.3969/j.issn.1672-5301.2022.06.001.
[8] Toste A.Advances in hypertrophic cardiomyopathy:what the cardiologist needs to know[J].Portuguese J Cardiol,2022,41(6):499-509.doi:10.1016/j.repc.2021.05.015.
[9] Lopes L R,Losi M A,Sheikh N,et al.Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry[J].Eur Heart J Qual Care Clin Outcomes,2022,9(1):42-53.doi:10.1093/ehjqcco/qcac006.
[10] Mielczarek S,Syska P,Lewandowski M,et al.Long-term mortality and risk factor analysis in hypertrophic cardiomyopathy patients with implantable cardioverter-defibrillators[J].Pol Arch Intern Med,2022,132(2):16206.doi:10.20452/pamw.16206.
[11] 伍熙，崔颢，肖明虎，等.梗阻性肥厚型心肌病患者发生肺高血压的病例对照研究[J].中华心血管病杂志，2016,44(12):1010-4.doi:10.3760/cma.j.issn.0253-3758.2016.12.004.[11] Wu X,Cui H,Xiao M H,et al.Prevalence of pulmonary hypertension in patients with hypertrophic obstructive cardiomyopathy:a case-control study[J].Chin J Cardiol,2016,44(12):1010-4.doi:10.3760/cma.j.issn.0253-3758.2016.12.004.
[12] Dominguez F,Sanz-Sánchez J,García-Pavía P,et al.Follow-up and prognosis of HCM[J].Glob Cardiol Sci Pract,2018,2018(3):33.doi:10.21542/gcsp.2018.33.
[13] 程子超，李海威，彭红玉，等.射血分数保留型心力衰竭相关性肺动脉高压研究进展[J].中国医药，2023,18(1):119-22.doi:10.3760/j.issn.1673-4777.2023.01.028.[13] Cheng Z C,Li H W,Peng H Y,et al.Research progress of heart failure with preserved ejection fraction associated pulmonary hypertension[J].China Med,2023,18(1):119-22.doi:10.3760/j.issn.1673-4777.2023.01.028.
[14] Kwon S,Kim H K,Kim B,et al.Comparison of mortality and cause of death between adults with and without hypertrophic cardiomyopathy[J].Sci Rep,2022,12(1):6386.doi:10.1038/s41598-022-10389-4.
[15] Nie C,Zhu C,Xiao M,et al.Risk factors of pulmonary arterial hypertension and its relationship with atrial fibrillation in patients with obstructive hypertrophic cardiomyopathy[J].Front Cardiovasc Med,2021,8:666431.doi:10.3389/fcvm.2021.666431.
基本信息:
DOI：10.19405/j.cnki.issn1000-1492.2025.02.024
中图分类号:R542.2;R544.1
引用信息:
[1]娜孜拉·努尔兰,唐雍淇,艾尼娃尔·艾克木等.合并肺动脉高压的肥厚型心肌病患者发生不良预后的危险因素[J].安徽医科大学学报,2025,60(02):351-357.DOI:10.19405/j.cnki.issn1000-1492.2025.02.024.
基金信息:
国家自然科学基金(编号：81660695); 天山创新团队计划(编号：2020D14032)~~