梗阻性肥厚型心肌病治疗新进展New advances in the treatment of hypertrophic obstructive cardiomyopathy
柳叶,吴强
摘要(Abstract):
在梗阻性肥厚型心肌病(HOCM)的治疗中,传统药物治疗虽能改善患者症状,但未能针对其发病机制延缓自然病程,存在局限性。外科室间隔心肌切除术疗效确切,却因创伤大、风险高而限制了其在临床上的广泛应用。同样,酒精室间隔消融术作为一种微创治疗手段,术后导致的房室传导阻滞等并发症也不容忽视。随着医学技术的不断进步,HOCM的治疗策略也在不断发展。本文旨在概述HOCM治疗领域的新进展。
关键词(KeyWords): 肥厚型心肌病;梗阻性肥厚型心肌病;药物治疗;外科手术;介入治疗
基金项目(Foundation): 贵州省科技平台及人才团队计划项目[黔科合平台人才(2017)5405]
作者(Author): 柳叶,吴强
参考文献(References):
- [1]Semsarian C,Ingles J,Maron MS,et al.New perspectives on the prevalence of hypertrophic cardiomyopathy[J].J Am Coll Cardiol,2015,65(12):1249-1254.DOI:10.1016/j.jacc.2015.01.019.
- [2]Elliott PM,Gimeno JR,ToméMT,et al.Left ventricular outflow tract obstruction and sudden death risk in patients with hypertrophic cardiomyopathy[J].Eur Heart J,2006,27(16):1933-1941.DOI:10.1093/eurheartj/ehl041.
- [3]Ommen SR,Ho CY,Asif IM,et al.2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the management of hypertrophic cardiomyopathy:a report of the American Heart Association/American College of Cardiology Joint Committee on clinical practice guidelines[J].Circulation,2024,149(23):e1239-e1311.DOI:10.1161/CIR.0000000000001250.
- [4]国家心血管病中心心肌病专科联盟,中国医疗保健国际交流促进会心血管病精准医学分会“中国成人肥厚型心肌病诊断与治疗指南2023”专家组.中国成人肥厚型心肌病诊断与治疗指南2023[J].中国循环杂志,2023,38(1):1-33.DOI:10.3969/j.issn.1000-3614.2023.01.001.
- [5]Ho CY,Olivotto I,Jacoby D,et al.Study design and rationale of EXPLORER-HCM:evaluation of mavacamten in adults with symptomatic obstructive hypertrophic cardiomyopathy[J].Circ Heart Fail,2020,13(6):e006853.DOI:10.1161/CIRCHEARTFAILURE.120.006853.
- [6]Tian Z,Li L,Li X,et al.Eff ect of Mavacamten on Chinese patients with symptomatic obstructive hypertrophic cardiomyopathy:the EXPLORER-CN randomized clinical trial[J].JAMA Cardiol,2023,8(10):957-965.DOI:10.1001/jamacardio.2023.3030.
- [7]Desai MY,Owens A,Wolski K,et al.Mavacamten in patients with hypertrophic cardiomyopathy referred for septal reduction:week 56 results from the VALOR-HCM randomized clinical trial[J].JAMA Cardiol,2023,8(10):968-977.DOI:10.1001/jamacardio.2023.3342.
- [8]Maron MS,Masri A,Choudhury L,et al.Phase 2 study of Aficamten in patients with obstructive hypertrophic cardiomyopathy[J].J Am Coll Cardiol,2023,81(1):34-45.DOI:10.1016/j.jacc.2022.10.020.
- [9]Coats CJ,Maron MS,Abraham TP,et al.Exercise capacity in patients with obstructive hypertrophic cardiomyopathy:SEQUOIA-HCM baseline characteristics and study design[J].JACC Heart Fail,2024,12(1):199-215.DOI:10.1016/j.jchf.2023.10.004.
- [10]Rastegar H,Boll G,Rowin EJ,et al.Results of surgical septal myectomy for obstructive hypertrophic cardiomyopathy:the Tufts experience[J].Ann Cardiothorac Surg,2017,6(4):353-363.DOI:10.21037/acs.2017.07.07.
- [11]Hang D,Schaff HV,Ommen SR,et al.Combined transaortic and transapical approach to septal myectomy in patients with complex hypertrophic cardiomyopathy[J].J Thorac Cardiovasc Surg,2018,155(5):2096-2102.DOI:10.1016/j.jtcvs.2017.10.054.
- [12]魏培坚,刘健,谭桐,等.胸腔镜经二尖瓣室间隔心肌切除术治疗左心室中部梗阻的肥厚型心肌病的早期效果[J].中华外科杂志,2023,61(3):214-219.DOI:10.3760/cma.j.cn112139-20220918-00399.
- [13]宋源凯,林红,简宇鹏,等.三维测量指导左室流出道疏通手术治疗肥厚型梗阻性心肌病及长期疗效[J].中国胸心血管外科临床杂志,2023,30(11):1580-1585.DOI:10.7507/1007-4848.202303079.
- [14]Spirito P,Binaco I,Poggio D,et al.Role of preoperative cardiovascular magnetic resonance in planning ventricular septal myectomy in patients with obstructive hypertrophic cardiomyopathy[J].Am J Cardiol,2019,123(9):1517-1526.DOI:10.1016/j.amjcard.2019.01.041.
- [15]Ma J,Liu J,Yuan H,et al.Two-port thoracoscopic myectomy for hypertrophic cardiomyopathy with three-dimensional printing[J].Ann Thorac Surg,2021,111(3):e165-e168.DOI:10.1016/j.athoracsur.2020.05.183.
- [16]Nguyen A,Schaff HV,Hang D,et al.Surgical myectomy versus alcohol septal ablation for obstructive hypertrophic cardiomyopathy:a propensity score-matched cohort[J].JThorac Cardiovasc Surg,2019,157(1):306-315.e3.DOI:10.1016/j.jtcvs.2018.08.062.
- [17]Batzner A,Pfeiff er B,Neugebauer A,et al.Survival after alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy[J].J Am Coll Cardiol,2018,72(24):3087-3094.DOI:10.1016/j.jacc.2018.09.064.
- [18]Liu L,Li J,Zuo L,et al.Percutaneous intramyocardial septal radiofrequency ablation for hypertrophic obstructive cardiomyopathy[J].J Am Coll Cardiol,2018,72(16):1898-1909.DOI:10.1016/j.jacc.2018.07.080.
- [19]Zhou M,Ta S,Hahn RT,et al.Percutaneous intramyocardial septal radiofrequency ablation in patients with drug-refractory hypertrophic obstructive cardiomyopathy[J].JAMA Cardiol,2022,7(5):529-538.DOI:10.1001/jamacardio.2022.0259.
- [20]Ta S,Li J,Hsi DH,et al.Percutaneous intramyocardial septal radiofrequency ablation after 5-year follow-up[J].Heart,2024,110 (11):792-799.DOI:10.1136/heartjnl-2023-323606.
- [21]Liu L,Zhou M,Zuo L,et al.Echocardiography Guided Liwen Procedure(TM)for the treatment of obstructive hypertrophic cardiomyopathy in a patient with prior aortic valve replacement surgery:Liwen procedure for intra-myocardial radiofrequency ablation[J].Echocardiography,2018,35(8):1230-1232.DOI:10.1111/echo.14040.
- [22]Li Y,Feng Y,Li X,et al.Case report:minimally invasive therapy by transcatheter aortic valve replacement and percutaneous intramyocardial septal radiofrequency ablation for a patient with aortic stenosis combined with hypertrophic obstructive cardiomyopathy:two-year follow-up results[J].Front Cardiovasc Med,2021,8:735219.DOI:10.3389/fcvm.2021.735219.
- [23]Xu Y,Yu TY,Pu ZX.Percutaneous intramyocardial s e p t a l radiofrequency ablation relieving residual left ventricular outflow tract obstruction following alcohol septal ablation[J].CASE (Phila),2022,6(7):340-343.DOI:1016/j.case.2022.06.003.
- [24]Jiang T,Huang B,Huo S,et al.Endocardial radiofrequency ablation vs.septal myectomy in patients with hypertrophic obstructive cardiomyopathy:a systematic review and metaanalysis[J].Front Surg,2022,9:859205.DOI:10.3389/fsurg.2022.859205.
- [25]贾玉和,华伟,姚焰,等.经皮心内膜肥厚室间隔射频消融术的临床应用现状与展望[J].中国心血管病研究,2021,19(4):381-384.DOI:10.3969/j.issn.1672-5301.2021.04.17.
- [26]Cooper RM,Shahzad A,Hasleton J,et al.Radiofrequency ablation of the interventricular septum to treat outflow tract gradients in hypertrophic obstructive cardiomyopathy:a novel use of CARTOSound?technology to guide ablation[J].Europace,2016,18(1):113-120.DOI:10.1093/europace/euv302.
- [27]Long X,Deng S,Liu W,et al.Transcoronary radiofrequency ablation for obstructive hypertrophic cardiomyopathy:a feasibility study[J].Eur Heart J,2024,45(3):233-235.DOI:10.1093/eurheartj/ehad741.
- [28]Khan JM,Bruce CG,Greenbaum AB,et al.Transcatheter myotomy to relieve left ventricular outflow tract obstruction:the septal scoring along the midline endocardium procedure in animals[J].Circ Cardiovasc Interv,2022,15(6):e011686.DOI:10.1161/CIRCINTERVENTIONS.121.011686.
- [29]Greenbaum AB,Khan JM,Bruce CG,et al.Transcatheter myotomy to treat hypertrophic cardiomyopathy and enable transcatheter mitral valve replacement:first-in-human report of septal scoring along the midline endocardium[J].Circ Cardiovasc Interv,2022,15(6):e012106.DOI:10.1161/CIRCINTERVENTIONS.122.012106.
- [30]Greenbaum AB,Ueyama HA,Gleason PT,et al.Transcatheter myotomy to reduce left ventricular outflow obstruction[J].JAm Coll Cardiol,2024,83(14):1257-1272.DOI:10.1016/j.jacc.2024.02.007.
- [31]Fang J,Liu Y,Zhu Y,et al.First-in-human transapical beating-heart septal myectomy in patients with hypertrophic obstructive cardiomyopathy[J].J Am Coll Cardiol,2023,82(7):575-586.DOI:10.1016/j.jacc.2023.05.052.
- [32]Spina R,Granger E,Walker B,et al.Ventricular tachycardia in hypertrophic cardiomyopathy with apical aneurysm successfully treated with left ventricular aneurysmectomy and cryoablation[J].Eur Heart J,2013,34(47):3631.DOI:10.1093/eurheartj/eht443.
- [33]Pozzoli A,Vicentini L,Thelin S,et al.Application of cryoenergy to improve septal exposure during transaortic septal myectomy in hypertrophic obstructive cardiomyopathy[J].Gen Thorac Cardiovasc Surg,2018,66(4):243-245.DOI:10.1007/s11748-017-0815-8.
- [34]Li X,Zhu Z,Liu J,et al.Septal radioablation therapy for patients with hypertrophic obstructive cardiomyopathy:first-inhuman study[J].Eur Heart J Open,2023,3(3):oead052.DOI:10.1093/ehjopen/oead052.
- [35]KapleR K,Murphy R T,DiPaola L M,et al.Mitral valve abnormalities in hypertrophic cardiomyopathy:echocardiographic features and surgical outcomes[J].Ann Thorac Surg,2008,85(5):1527-1535,1535.e1-2.DOI:10.1016/j.athoracsur.2008.01.061.
- [36]Sherrid MV,Balaram S,Kim B,et al.The mitral valve in obstructive hypertrophic cardiomyopathy:a test in context[J].J Am Coll Cardiol,2016,67(15):1846-1858.DOI:10.1016/j.jacc.2016.01.071.
- [37]Vriesendorp PA,Schinkel AF,Soliman OI,et al.Longterm benefit of myectomy and anterior mitral leaflet extension in obstructive hypertrophic cardiomyopathy[J].Am J Cardiol,2015,115(5):670-675.DOI:10.1016/j.amjcard.2014.12.017.
- [38]Sorajja P,Pedersen WA,Bae R,et al.First experience with percutaneous mitral valve plication as primary therapy for symptomatic obstructive hypertrophic cardiomyopathy[J].JAm Coll Cardiol,2016,67(24):2811-2818.DOI:10.1016/j.jacc.2016.03.587.
- [39]Kwon DH,Smedira NG,Thamilarasan M,et al.Characteristics and surgical outcomes of symptomatic patients with hypertrophic cardiomyopathy with abnormal papillary muscle morphology undergoing papillary muscle reorientation[J].J Thorac Cardiovasc Surg,2010,140(2):317-324.DOI:10.1016/j.jtcvs.2009.10.045.
- [40]Ommen SR,Mital S,Burke MA,et al.2020 AHA/ACCGuideline 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-e631.DOI:10.1161/CIR.0000000000000937.