室间隔酒精消融术后左心室流出道压差下降幅度及影响因素分析

Decreasing amplitude of left ventricular outflow tract gradient and its influencing factors after alcohol septal ablation

目的观察室间隔酒精消融术(alcohol septal ablation,ASA)治疗肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy,HOCM)后左心室流出道压差(left ventricular outflow tract gradient,LVOTG)的下降幅度,并分析其影响因素。方法收集本院2011年8月至2019年8月行ASA治疗的HOCM患者58例,比较手术前后超声心动图的变化(中位随访34 d),评估术后LVOTG的下降幅度。根据LVOTG是否降低50%分为LVOTG下降显著组(LVOTG下降≥50%)及不显著组(LVOTG下降<50%),对比两组患者的临床资料,分析LVOTG下降显著的独立影响因素,并对影响因素作ROC曲线分析。结果58例患者ASA术后LVOTG为(46.13±39.31)mmHg,较术前(90.77±33.38)mmHg显著下降(P<0.05),术后室间隔厚度、左房内径、二尖瓣反流面积、二尖瓣收缩期前向运动征均显著减少(P<0.05)。多因素logistic回归分析显示,酒精剂量(OR 3.222,95%CI:1.345~7.717,P=0.009)是短期LVOTG下降显著的独立影响因素,ROC曲线下面积(AUC)为0.707(95%CI:0.573~0.841,P=0.009)。结论ASA可有效降低HOCM患者的LVOTG,接受高剂量酒精消融的患者LVOTG下降的幅度更显著。

Objective To analyze the decreasing amplitude of left ventricular outflow tract gradient(LVOTG)and its influencing factors after alcohol septal ablation(ASA)in treatment of hypertrophic obstructive cardiomyopathy(HOCM).Methods A total of 58 HOCM patients treated by ASA in our hospital from August 2011 to August 2019 were recruited in this study.The changes of echocardiography before and after ASA(a median follow-up period of 34 d)were compared to evaluate the decreasing amplitude of LVOTG after surgery.According to whether the LVOTG was decreased by 50%,the patients were divided into the significant LVOTG decline group(LVOTG decline≥50%)and the non-significant decline group(LVOTG decline<50%).The clinical data were compared between the 2 groups.The independent influential factors of significant LVOTG decline were analyzed,and receiver operation characteristic(ROC)curve analysis was also performed for the influencing factors.Results The LVOTG of the 58 patients was decreased from 90.77±33.38 mmHg preoperatively to 46.13±39.31 mmHg(P<0.05).The interventricular septum thickness,left atrial diameter,mitral regurgitation area and systolic anterior motion were all significantly reduced after surgery(P<0.05).Multivariate logistic regression analysis indicated that alcohol dose(OR=3.222,95%CI:1.345~7.717,P=0.009)was an independent influencing factor of significant LVOTG decline in short term,with the area under curve(AUC)of 0.707(95%CI:0.573~0.841,P=0.009).ConclusionASA can effectively reduce LVOTG in HOCM patients.And the higher the alcohol dose is,the more significant the decreasing amplitude is.