肥厚型心肌病的超声心动图征象与肺动脉高压关系的探讨

目的:探讨肥厚型心肌病(HCM)的超声心动图征象与肺动脉高压(PH)之间的关系。方法:92例成年HCM患者按照肺动脉压力分为3组,对3组患者的各项超声心动图指标进行比较,同时采用一元和多元线性回归分析各参数与右室收缩压(RVSP)的独立相关关系,并用ROC曲线选取判定RVSP的最佳参数。结果:①34%的患者存在PH,3组患者的性别、纽约心脏病协会心功能分级(NYHA)比例和症状相似,与B组患者比较,C组患者的年龄更大(P=0.001 4)、运动能力更低(P=0.018)。②C组患者的左房压更高(P=0.025),静息状态左室流出道(LVOT)压差更高(P=0.000 1),E/e’值也更高(P=0.001)。③3组患者除了右室舒张早期应变率(RV-ESR)差异有统计学意义(P=0.01),室间隔和右室游离壁的其他形变参数差异均无统计学意义。④一元分析提示,年龄(P<0.001)、左房容积(P=0.006 7)、静息LVOT压差(P<0.001)、左室E/e’比值(P<0.001)和代谢当量(METs)(P=0.002 1)均与RVSP相关。多元分析显示,左房压(β-coefficient=-1.575,P<0.001)、静息LVOT压差(β-coefficient=0.425,P=0.001)与RVSP独立相关。⑤ROC曲线显示静息LVOT压差用于预测RVSP的敏感性为73%,特异性为69%,曲线下面积为0.87。结论:年龄、左房容积、左室E/e’值、静息LVOT压差及METs与HCM患者PH相关。多元分析提示,左房容积、静息LVOT压差与RVSP独立相关。

The association between echocardiogram characteristics and pulmonary hypertension in hypertrophic cardiomyopathy

Objective：To determine the association between echocardiogram characteristics and pulmonary hypertension in hypertrophic cardiomyopathy.Methods：Ninety-two patients were classified into three groups based on RVSP,the three groups were comparable with regards to various kinds of echocardiogram characteristics,and the relation between various kinds of features and RVSP were analysed by univariate analysis and multivariable analysis.Results：①In our study cohort,PH（RVSP ≥35 mmHg）was noted in 34%.The three groups were comparable with regards to gender,proportion of NYHA class of III/IV and symptoms.Group 3 patients were older（P=0.0014）and had lower exercise capacity（P=0.018）compared to the other 2 groups.②Group 3 patients had a larger LA volume（P=0.025）,higher resting LVOT gradient（P=0.0001）and higher E/e’ ratio（P=0.001）.The other echocardiography variables were not significant different.③Except for a difference in global RV-ESR（P=0.01）,all deformation variables were similar across the 3 groups for the ventricular septum and RV free wall suggesting a similar myopathic process across the groups.④Univariate analysis showed that age（P〈0.001）,LA volume（P=0.0067）,resting LVOT gradient（P〈0.001）,LV E/e’ ratio（P〈0.001）and METs（P=0.0021）were associated with RVSP.Multivariable analysis including these features indicated that only LA volume（-coefficient=-1.575,P〈0.001）and resting LVOT gradient（-coefficient=0.425,P=0.001）were independently associated with RVSP.⑤Receiver operating characteristic analysis demonstrated that resting LVOT gradient had 73% sensitivity and 69% specificity to predict RVSP≥35 mmHg with an area under the curve of 0.87.Conclusion：Age,LA volume,LV E/e’ ratio,resting LVOT gradient and METs are correlated with RVSP in patients with HCM.Multivariate analysis demonstrated that LA volume and resting LVOT gradient were independently associated with RVSP in HCM.