肥厚型心肌病患者发生晕厥的危险因素分析

Predictors of syncope in patients with hypertrophic cardiomyopathy

目的探讨肥厚型心肌病患者晕厥发生的相关危险因素。方法入选肥厚型心肌病患者,所有患者进行为期2年的随访,根据是否发生晕厥分成有晕厥组和无晕厥组两组,比较两组的临床特征、心电图指标、超声心动图指标及运动试验中的血压反应性,并通过回归分析探讨晕厥发生的相关危险因素。结果共入选151例患者,其中41例患者发作晕厥,占27.2%。单因素Logistic回归分析提示碎裂QRS波、非持续性室性心动过速(简称室速)、左室壁最大厚度≥30mm和运动试验中异常的血压反应是晕厥发生的预测因素,多因素Logistic回归分析提示非持续室速和运动试验中异常的血压反应是晕厥发生的独立预测因素,两者的比值比分别为13.1和9.1,同时存在上述两项危险因素预测晕厥发生的特异度为99.0%,敏感度为61.1%。结论非持续性室速和运动试验中异常的血压反应是肥厚型心肌病患者晕厥发作的独立预测因子。

Objective To determine the predictors of syncope in patients with hypertrophic cardiomyopathy （HCM）. Methods Patients with HCM were enrolled. During the two years follow-up, the patients were divided into two groups according to have syncope or not. We compared the clinical, electrocardiographic, and echocardiographic factors of the two groups, and used the regression analysis to determine the predictors of syncope. Results One hundred and fifty-one patients were enrolled. Forty-one patients occurred syncope, taken up 27.2 %. Univariate Logistic analysis showed fragment QRS, nonsustained ventricular tachycardia, maximal LV wall thickness larger than thirty millimeter and abnormal blood pressure response in exercise testing were predictors of syncope. Multivariate Logistic analysis showed nonsustained ventricular tachycardia and abnormal blood pressure response in exercise testing were independent predictors of syncope. The odd ratios of the two predictors were 13.1 and 9.1. The concomitant occurrence of two variables had a sensitivity of 61.1% and specificity of 99.0% in identifying the patients with syncope events. Conclusion Nonsustained ventricular tachycardia and abnormal blood pressure response in exercise testing are independent predictors of syncope in HCM patients. [Chinese Journal of Cardiac Pacing and Electrophysiology, 2016,30 （3） ： 234- 237]