刘蓉,乔树宾,胡奉环,杨伟宪,袁建松,崔锦刚,许亮

• 1:中国医学科学院北京协和医学院国家心血管病中心阜外医院冠心病研究中心

摘要(Abstract)：

目的分析梗阻性肥厚型心肌病患者行经皮室间隔无水酒精化学消融术(化学消融术)预后与冠状动脉间隔支特点的相关性。方法纳入2010年1月至2013年1月资料完整的55例梗阻性肥厚型心肌病行化学消融术的患者,术前及术后12个月行超声心动图检查,根据左心室流出道压差是否下降50%分为预后良好组(28例)及预后不佳组(27例),定量冠状动脉造影(QCA)分析比较两组患者消融间隔支直径和长度、相邻间隔支直径和长度、消融间隔支支数、相邻间隔支和消融间隔支距离、消融间隔支至前降支开口距离及对比剂滞留面积等指标。结果两组患者术前及随访12个月消融间隔支长度、相邻间隔支直径、相邻间隔支长度、间隔支至冠状动脉开口距离、间隔支数量、对比剂滞留面积、无水酒精用量等比较,差异均无统计学意义(均P>0.05);而预后良好组患者消融间隔支直径[(1.75±0.36)mm比(1.48±0.41)mm,P=0.012]、消融间隔支与相邻间隔支距离[(18.80±10.20)mm比(13.04±6.65)mm,P=0.020]显著大于预后不佳组,差异有统计学意义。多因素logistic分析显示,消融间隔支直径(OR 9.258,95%CI 1.427~60.069,P=0.020)和消融间隔支与相邻间隔支距离(OR1.102,95%CI 1.002~1.213,P=0.046)是预后良好的预测因子。结论冠状动脉特点与化学消融术预后有一定相关性,消融间隔支粗大及消融间隔支与相邻间隔支距离较大的患者预后更好。

关键词(KeyWords)： 肥厚型心肌病;间隔支;消融;预后

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 刘蓉,乔树宾,胡奉环,杨伟宪,袁建松,崔锦刚,许亮

参考文献(References)：

• [1]Nagueh SF,Groves BM,Schwartz L,et al.Alcohol septal ablation for the treatment of hypertrophic obstructive cardiomyopathy.A multicenter North American registry.J Am Coll Cardiol,2011,58(22):2322-2328.
• [2]丁建,李占全.儿童梗阻性肥厚型心肌病患者四例行化学消融的疗效及安全性初探.中国介入心脏病学杂志,2014,22(3):146-148.
• [3]Rigopoulos AG,Seggewiss H.A decade of percutaneous septal ablation in hypertrophic cardiomyopathy.Circ J,2011,75(1):28-37.
• [4]Sorajja P,Ommen SR,Holmes DR Jr,et al.Survival after alcohol septal ablation for obstructive hypertrophic cardiomyopathy.Circulation,2012,126(20):2374-2380.
• [5]Steggerda RC,Damman K,Balt JC,et al.Periprocedural complications and long-term outcome after alcohol septal ablation versus surgical myectomy in hypertrophic obstructive cardiomyopathy:a single-center experience.JACC Cardiovasc Interv,2014,7(11):1227-1234.
• [6]Veselka J,KrejˇcíJ,Tomaˇsov P,et al.Long-term survival after alcohol septal ablation for hypertrophic obstructive cardiomyopathy:a comparison with general population.Eur Heart J,2014,35(30):2040-2045.
• [7]Agarwal S,Tuzcu EM,Desai MY,et al.Updated meta-analysis of septal alcohol ablation versus myectomy for hypertrophic cardiomyopathy.J Am Coll Cardiol,2010,55(8):823-834.
• [8]Pfeiffer B,Rigopoulos A,SeggewiβH.Myocardial contrast echocardiography guided alcohol septal ablation in hypertrophic obstructive cardiomyopathy with a new echocardiographic contrast agent.Dtsch Med Wochenschr,2012,137(41):2093-2096.
• [9]Valeti US,Nishimura RA,Holmes DR,et al.Comparison of surgical septal myectomy and alcohol septal ablation with cardiac magnetic resonance imaging in patients with hypertrophic obstructive cardiomyopathy.J Am Coll Cardiol,2007,49(3):350-357.
• [10]Singh M,Edwards WD,Holmes DR Jr,et al.Anatomy of the first septal perforating artery:a study with implications for ablation therapy for hypertrophic cardiomyopathy.Mayo Clin Proc,2001,76(8):799-802.
• [11]Wallace EL,Thompson JJ,Faulkner MW,et al.Septal perforator anatomy and variability of perfusion bed by myocardial contrast echocardiography:a study of hypertrophic cardiomyopathy patients undergoing alcohol septal ablation.J Interv Cardiol,2013,26(6):604-612.
• [12]Steggerda RC,Balt JC,Damman K,et al.Predictors of outcome after alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy.Special interest for the septal coronary anatomy.Neth Heart J,2013,21(11):504-509.
• [13]Gersh BJ,Maron BJ,Bonow RO,et al.2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Developed in collaboration with the American Association for Thoracic Surgery,Amerian Society of Echocardiography,American Society of Nuclear Cardiology,Heart Failure Society of American,Heart Rhythm Society,Society for Cardiovascular Angiography and Interventions,and Society of Thoracic Surgeons.J Am Coll Cardiol,2011,58(25):e212-e260.
• [14]Elliott PM,Anastasakis A,Borger MA,et al.2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy:the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology(ESC).Eur Heart J,2014,35(39):2733-2779.