肥厚型心肌病临床特点和长期预后的回顾性分析

Retrospective analysis of clinical features and long-term prognosis of hypertrophic cardiomyopathy

目的探讨肥厚型心肌病(HCM)的临床特点及影响长期预后的因素。方法回顾分析117例经超声心动图检查确诊的HCM患者的临床资料、ECG、超声心动图特点。结果患者的主要症状为心前区不适、胸痛、心悸、呼吸困难、头晕、晕厥、心脏杂音等。ECG主要表现为房性期前收缩、心房颤动、房性心动过速、室性心动过速、合并异常Q波、ST-T改变、左心室高电压等。平均追踪随访(4.5±2.8)年,死亡18例,猝死3例,心力衰竭、肺部感染死亡4例,脑卒中死亡4例,肿瘤及其相关原因死亡7例。患者年龄、性别、症状和超声心动图参数与患者的预后无明确的相关性。结论HCM临床表现并不特异,超声心动图具有重要的诊断价值。

Objectives To explore the clinical features and long-term prognosis of hypertrophic cardiomyopathy（HCM）. Methods The clinical data of patients admitted to Peking Union Medical College Hospital between 2 003 and 2 006 with the diagnosis of HCM were reviewed and analyzed retrospectively. A total of 117 cases with diagnosis of HCM were reviewed,and the diagnosis of each case was confirmed by echocardiography（UCG）. Results The symptoms included precordial distress, pectoralgia, palpitation, dyspnea, dizziness, syncope, and heart murmur. The major electrocardiographic presentations were premature beats,atrial fibrillation,atrial tachycardia, ventricular tachycardia,accompanied by abnormal Q wave, ST-T changes, left ventricular high voltage, etc. Eighteen patients died,of whom,3 were sudden deaths,4 died of heart failure and pulmonary infection,4 died of cerebral infarction,and 7 died of tumor or other causes. Conclusions There were no specific presentations of HCM,and UCG had important diagnostic value. Cardiac death was not the major cause of death among the studied cases. There was no prognostic value for age, gender, symptoms,and the parameters of electrocardiogram and UCG.