心尖肥厚型心肌病患者的冠状动脉病变特点及其预后分析

目的总结心尖肥厚型心肌病（AHCM）患者的冠状动脉病变特点，并对心尖肥厚型心肌病预后的影响因素进行分析。方法连续人选自2005年1月至2012年8月经超声心动图和（或）心脏磁共振成像确诊为心尖肥厚型心肌病并进行了冠状动脉造影或多排螺旋CT（MDCT）检查的患者共240例，总结其冠状动脉病变特点，并分析冠状动脉病变对AHCM预后的影响。结果74例（30．83％）患者合并冠心病，其中单支病变32例，双支病变25例，三支病变17例；33例经皮行冠状动脉介入治疗（PCI），2例行冠状动脉旁路移植术（CABG），余39例采取单纯药物治疗。23例（9．58％）患者合并冠状动脉肌桥，受累血管均为前降支单支病变；其中1例经皮行冠状动脉介入治疗（PCI），1例行冠状动脉旁路移植术（CABG），余21例采取单纯药物治疗。合并冠心病组（74例）与非冠心病组（143例）比较，前者平均年龄、平均糖化血红蛋白水平及高血压病史的比例均高于后者（P〈0．05）；合并冠心病组预后较冠脉正常组差，Cox比例风险回归模型多因素分析发现，左室射血分数（HazardRatio==0．826，95％C10．746—0．915，P=0．001）和左房前后径大小（HazardRatio--1．423，95％CI：1．142-1．773，P=0．002）是影响AHcM合并冠心病预后的独立危险因素。结论应当对高龄、以胸痛主诉、合并高血压病及平均糖化血红蛋白水平均较高的AHCM患者常规进行冠状动脉检查；合并冠心病对AHCM预后有不良影响；LVEF和左房前后径大小是AHCM合并冠心病预后的独立危险因素。

i The Incidence of Coronary Artery Disease and Prognostic Analysis in Patients with Apical Hypertrophic Cardiomyopathy

Objective The purpose of this study was to analyze the incidence of coronary artery disease（CAD） and the prognosis in patients with apical hypertrophic cardiomyopathy （AHCM）. Methods We retrospectively reviewed 240 patients with AHCM evaluated by echocardiography and/or cardiac magnetic resonance （CMR） from January 2005 to August 2012 and underwent coronary angiography or MDCT for detecting coronary artery disease. Cox regtestion analysis was used to find the predictors of the cardiac events. Results Two hundred and forty patients were divided into normal group （ 143 cases）, myocardial bridge group（23 cases） and coronary ~ disease group（74 cases）.The CAD group was divided into three groups： single vessel coronary disease group （32 cases）,double vessel coronary disease group（25 cases）and three vessel vessel coronary disease group（17 cases）. Coronary artery bypass graft and petcutancous coronary intervention（PCI） were performed in 35 cases. Patients with CAD had larger mean age（60.18 vs 55.76 years, P-~.003）, more hyper~nsinn（77% vs 55%, P=0.002）, higher level haemoglobinAle （6.21 vs 5.77, P=0.03）, The incidence of cardiac events in CAD group was higher than normal group. LVEF （Hazard Rafio-------~.826, 95 % CI 0.746-0.915, P=0.001） and LAd（ Hazard Ratio=1.423, 95% CI： 1.142-1.773, P-4）.002） are the independent prognostic factors in AHCM with CAD. Conclusion Coronary artery screening is necessary in AHCM patients. CAD is a independent prognostic factor of AHCM. Increased LAd and reduced LVEF were positively related to a poorer prognosis in AHCM with CAD.