心肌致密化不全心肌病伴慢性心力衰竭患者的临床研究

Clinical profiles of patients with noncompaction cardiomyopathy accompanied by chronic heart failure

目的目前致密化不全心肌病影像学诊断标准基于心肌致密层与非致密层比值、非致密心肌厚度或肌小梁数目。患者临床表现包括无症状到心律失常、心力衰竭、血栓栓塞甚至心源性猝死。本研究旨在观察致密化不全心肌病患者临床特征及其对预后的影响。方法回顾性研究2001年1月—2016年12月中国科学技术大学附属第一医院(安徽省立医院)收治的致密化不全心肌病伴心力衰竭患者60例(研究组),同期住院的扩张型心肌病71例患者作为对照组,分析致密化不全心肌病临床特征,评价其对患者预后的影响。结果与对照组比较,致密化不全心肌病患者男性比例高(68.33%vs. 47.89%,P=0.018),更易出现左束支传导阻滞(56.67%vs. 29.58%,P=0.002)和右束支传导阻滞(6.67%vs. 0.00%,P=0.043),心电图碎裂QRS波发生率(23.33%vs. 8.45%,P=0.018)增加,以室性心律失常事件作为终点的logistic多因素回归分析显示,男性(P=0.028)是室性心律失常发生的重要因素。以室性心律失常和/或栓塞为复合终点的logistic多因素回归分析显示,高血压(P=0.024)是影响复合终点的重要因素。结论心肌致密化不全患者易出现心电异常,其中男性是室性心律失常的重要影响因素,若伴有高血压,将增大栓塞事件发生率。

Objective Imaging standards of diagnosis of ventricular noncompaction cardiomyopathy(VNC)are based on the ratio of dense layer to non-dense layer,the thickness of non-dense myocardium or the number of myocardial trabeculae.Patients have clinical manifestations,ranging from asymptomatic to arrhythmia,heart failure,thromboembolism or sudden cardiac death.The purpose of this study was to explore clinical characteristics(CCs)of patients with VNC accompanied by chronic heart failure(VNC-CHF)and their influence on prognosis.Methods From January 2001 to December 2016,the patients with VNC-CHF in the First Affiliated Hospital of USTC(n=60,as research group)and the patients with dilated cardiomyopathy(n=71,as control group)in the hospital were retrospectively studied.Their CCs were analyzed and the influence on the patients’prognosis was evaluated.Results Compared with the control group,the proportion of male patients with VNC-CHF was higher than that of female patients(68.33%vs.47.89%,P=0.018),and they were more likely to have left bundle branch block(56.67%vs.29.58%,P=0.002)and right bundle branch block(6.67%vs.0.00%,P=0.043).The incidence of fragmented QRS complexes(23.33%vs.8.45%,P=0.018)was significantly increased.Logistic regression analysis showed that gender(P=0.028)and hypertension(P=0.024)were important factors in the occurrence of ventricular arrhythmia(VA)and the composite point which was composed of VA and embolism,respectively.The incidence of VA in male patients was higher than that in female patients.Conclusion VNC patients are prone to ECG abnormalities,in which male is an independent factor of VA,with poor prognosis.Hypertension in VNC patients will increase the incidence of embolism.