经股动脉左心室起搏预测梗阻性肥厚型心肌病化学消蚀术即刻疗效Predictive value of left ventricular endocardial pacing in percutaneous transluminal septal myocardial ablation of hypertrophic obstructive cardiomyopathy
任节,戴振林,张俊杰,刘志忠,叶飞,段宝祥,陈绍良
摘要(Abstract)：
目的梗阻性肥厚型心肌病(HOCM)猝死率高,经皮室间隔化学消蚀术(PTSMA)和左室心内膜起搏的关系至今未见报道。本文拟探讨左心室心内膜起搏预测HOCM化学消蚀术疗效的价值。方法对静息左心室流出道压力阶差(LVOTG)≥30mmHg和/或激发LVOTG≥50mmHg的HOCM患者进行左心室心内膜起搏,20min后行PTSMA,通过Swan-Ganz导管连续记录有创血流动力学参数及LVOTG,术后临床及超声随访1个月。结果15例患者PTSMA术前室间隔平均厚度为22.07±7.85mm,术后1个月减为17.39±5.79mm(P<0.01);术前静息LVOTG为56.02±32.86mmHg,术后1个月降为15.23±6.67mmHg(P<0.001),术前激发LVOTG为74.87±32.52mmHg,术后1个月降为20.53±12.28mmHg(P<0.001)。左心室起搏前静息LVOTG为50.40±39.41mmHg,起搏10min后显著减少至26.69±26.30mmHg,P<0.05;左心室起搏前激发LVOTG为122.53±52.52mmHg,左室起搏10min后降为56.60±43.87mmHg,P<0.05;经洗脱期行PTSMA后静息LVOTG则减少至13.73±12.45mmHg,与术前比P<0.05;PTSMA后激发LVOTG为32.80±18.42mmHg,与术前比P<0.01。其中,左室起搏治疗有效10例,无效5例;PTSMA治疗有效12例,无效3例。统计分析显示两种方法疗效显著相关(相关系数Kappa值=0.842,P=0.001)。结论左室心内膜起搏和PTSMA治疗HOCM疗效密切相关,提示PTSMA术前行左室心内膜起搏可预测其疗效。
关键词(KeyWords)： 心脏起搏,人工;心肌病,肥厚型;导管消融术;超声心动描记术
基金项目(Foundation):
作者(Author): 任节,戴振林,张俊杰,刘志忠,叶飞,段宝祥,陈绍良
参考文献(References)：
- [1]陈绍良,段宝祥,何晓红,等.梗阻性肥厚型心肌病经皮化学消蚀术后长期随访研究.中国介入心脏病学杂志,2003,11:21-24.
- [2]中华心血管病杂志编委会经皮经腔间隔心肌消蚀术治疗专题组.经皮经腔间隔心肌消蚀术治疗的参考意见.中华心血管病杂志,2001,29:434-435.
- [3]Geisterfer-Lowrance AA,Kass S,Tanigawa G,et al.A molecu-lar basis for familial hypertrophic cardiomyopathy:a beta cardiac myosin heavy chain gene missense mutation.Cell,1990,62:999-1006.
- [4]Marian Aj,Roberts R.The molecular genetic basis for hyper-trophic cardiomyopathy.J Mol Cell Cardiol,2001,33:655-670.
- [5]张明,李占全,金元哲,等.经皮经腔间隔心肌化学消蚀术治疗肥厚型梗阻性心肌病两年疗效观察.中华心血管病杂志,2003,31:122-125.
- [6]Sigwart U.Non-surgical myocardial reduction for hypertrophic ob-structive cardiomyopathy.Lancet,1995,346:211-214.
- [7]Seggewiss H,Falser L,Gleichmann U.Percutaneous transluminal septal ablation in hypertropic obstructive cardiomyopathy.Thorac Cardiovase Surg,1999,47:94-100.
- [8]辽宁省化学消蚀术协作组.经皮经冠状动脉室间隔化学消蚀术治疗梗阻型心肌病近期疗效观察.中华心血管病杂志,2001,29:8-11.
- [9]陈振云,熊海刚,裘哲君,等.心脏起搏器治疗梗阻性肥厚型心肌病远期临床及血液动力学观察.中国心脏起搏与心电生理杂志,1998,12:177-178.
- [10]Abdelkader Touiza,Yves Etienne,Martine Gilard.Long-term left ventricular pacing:Assessment and comparison with biventricular pacing in patients with severe congestive heart failure.J Am Coll Cardiol,2001,38:1966-1970.
- [11]Yufu K,Takahashi N.Improved hypertropic obstructive cardio-myopathy by left ventricular apex epicardial pacing.Internal Medicine,2004,43:295-299.
- [12]Honda T,Shono H,Koyama J,et al.Impact of right atrial-left Ventricular dual-chamber permanent pacing in patients with se-verely symptomatic obstructive cardiomyopathy.Circ J,2005,69:536-542.
- [13]Pezzulich B,Montagna L,Lucchina PG.Successful treatment of end-stage hypertropic cardiomyopathy with biventricular cardiac pacing.Europace,2005,7:388-391.
- [14]Komsouglu B,Vural A,Aqacdiken A,et al.Effect of biventricular pacing on left ventricular outflow tract pressure gradient in a pa-tient with hypertropic cardiomyopathy and normal interventricular conduction.J Cardiovasc Electrophysiol,2006,17:207-209.