起搏治疗梗阻性肥厚型心肌病的长期疗效

Long-term effects of pacing on obstructive hypertrophic cardiomyopathy

目的评价起搏治疗对梗阻性肥厚型心肌病(obstructive hypertrophic cardiomyopathy,OHCM)左心室流出道梗阻及临床症状的长期疗效。方法25例OHCM患者接受起搏治疗,临床随访12个月,观察临床症状体征;采用超声心动图观察起搏前后室间隔厚度(interventricular septum thickness,IVS)、左心室后壁厚度(left ventricular posterior wall thickness,LVPW)、左心室舒张末内径(left ventricular end diastolic dimension,LVEDd)、左心室收缩末内径(left ventricular end systolic dimension,LVEDs)、左心房内径(left atrial dimension,LAD)、跨左心室流出道压力阶差(left ventricular outflow tract gradient,LVOTG)、及二尖瓣前向运动程度(mitral valve systolic anterior motion,SAM)、二尖瓣反流面积(mitral valve area,MVA)的变化。结果OHCM 25例,植入双腔生理性起搏器(DDD)21例,占84%,单腔抑制频率调节起搏(SSIR)4例,占16%。起搏治疗12个月后,临床症状明显改善,15例晕厥发作术后症状完全消失,劳力性呼吸困难、胸痛改善分别占82.6%和75.0%,LVOTG显著下降,从术前(90±24)mmHg降至术后(37±13)mmHg(P<0.01),IVS、LAD、MVA减少,SAM运动明显改善,其他指标差异无统计学意义。结论起搏治疗对OHCM长期临床效果满意。

Objectives To assess the long-term results of pacing in patients with obstructive hypertrophic cardiomyopathy（OHCM）. Methods Twenty-five patients with OHCM were treated with pacemaker therapy. Data of clinical symptoms, hemodynamic parameters, obtained from echocardiography, were collected before implantation and then for a period of the following 12 months. Results Twenty-one patients were implanted dual-chamber pacemaker, and four patients were treated with single-chamber pacing. During the follow-up period, the syncope attacks were eliminated in 15 cases, the dyspnea and chest pain were significantly improved in 82.6% and 75.0% patients respectively, the left ventricular outflow tract gradient （LVOTG） notably decreased from （90±24） mm Hg to （37±13） mm Hg （P〈0.01）, and the mitral valve systolic anterior motion （SAM） and mitral regurgitation were both distinctly improved. Conclusions Pacing treatment is effective in reducing the LVOTG and improving symptoms in patients with OHCM.