肥厚型心肌病化学消融术疗效与冠状动脉特点的相关性研究

Correlation between the prognosis of alcohol septal ablation in hypertrophic obstructive cardiomyopathy and characteristics of the septal branch

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。

Objective To analyze the correlation between septal branch characteristics and the prognosis of alcohol septal ablation （ASA） in patients with hypertrophic obstructive cardiomyopathy. Methods The clinical, echocardiographic, angiographic and procedural characteristics were analyzed retrospectively in 55 patients. Good prognosis was defined as left ventrieular outflow tract gradient decreased by 50% at long term follow-up. The characteristics of septal branch were analyzed in terms of QCA. Results There were no differences in the length of the ablated septal branch, sizes of the adjacent branches, distances between the septal branch and the ostia of the coronary arteries and the volume of alcoholo consumed （ all P 〉 0. 05 ）. Compared with poor prognosis group （n = 27 ）, the diameter of the ablated septal branches were significantly larger in the good prognosis group （n =28） [（1.75 ±0.36）mm vs. （1.48 ±0.41）mm,P = 0. 012 ]. The distance between the ablated branch and its adjacent branch was farer in the good prognosis group [（18.80_＋10.20）mm vs. （13.04 ＋6.65）mm, P =0.020]. In multivariate analysis, the diameter of the ablated branch （ OR 9. 258,95% CI 1. 427 - 60. 069, P = 0. 020） and the distance between the ablated septal branch and its adjacent septal branch （OR 1. 102,95% CI 1.002 -1.213, P =0.046） were found to be independent risk factors for good prognosis of ASA. Conclusions The diameter of the ablated septal branch and the distance between its adjacent septal branch are associated with better prognosis of ASA.