心尖肥厚型心肌病和典型肥厚型心肌病的临床特征比较

Comparison of clinical characteristics between apical and classic hypertrophic cardiomyopathy

目的 探究与典型肥厚型心肌病(hypertrophic cardiomyopathy,HCM)相比心尖HCM患者的临床特征。方法 分析2001年8月至2023年3月于北京大学人民医院住院期间诊断为HCM的患者,根据心肌肥厚部位分为心尖HCM组和典型HCM组,比较其临床特征。结果 共纳入594例HCM患者,包括132例心尖HCM (22.2%)和462例典型HCM患者(77.8%)。心尖HCM患者的确诊年龄更大[(56.0±13.5)岁比(50.9±14.9)岁,P<0.001],有HCM家族史的更少(2.3%比8.0%,P=0.020)。心尖HCM的脑钠肽(brain natriuretic peptide,BNP)水平较典型HCM患者更低[145.0 (72.0,374.0)pg/ml比466.4 (226.0,950.8)pg/ml,P<0.001];更常伴左室高电压(63.6%比39.6%,P<0.001)与T波倒置(91.5%比58.5%,P<0.001)。心尖HCM患者出现左房扩大的比例更少(43.9%比55.4%,P=0.020),左室射血分数更高[69.15 (64.05,73.98)%比66.70 (60.36,72.85)%,P=0.009]。住院期间心尖HCM组患者不良结局的发生率更低(0.8%比7.8%,P=0.007)。结论 心尖HCM患者通常确诊年龄更大、有HCM家族史的更少、BNP水平更低、存在左室高电压和T波倒置的更多、心功能更好、预后也更好。

Objective To explore the clinical characteristics of apical hypertrophic cardiomyopathy(ApHCM)and classic HCM.Methods Patients diagnosed with HCM during hospitalization in Peking University People's Hospital from August 2001 to March 2023 were included in this study.According to the location of myocardial hypertrophy,patients were divided into ApHCM group and classic HCM group and their clinical characteristics were compared between the groups.Results A total of 594 HCM patients were analyzed,including 132(22.2%)ApHCM and 462(77.8%)classic HCM patients.ApHCM patients were older at diagnosis(56.0±13.5 vs.50.9±14.9 years,P<0.001)and had less positive HCM family history(2.3%vs.8.0%,P=0.020).The brain natriuretic peptide(BNP)level was lower in ApHCM compared to classic HCM patients[145.0(72.0,374.0)pg/ml vs.466.4(226.0,950.8)pg/ml,P<0.001].LV high voltage(LVHV)(63.6%vs.39.6%,P<0.001)and T wave inversion(91.5%vs.58.5%,P<0.001)were more common in ApHCM patients.Left atrial enlargement was less common(43.9%vs.55.4%,P=0.020)and LV ejection fraction was higher[69.15(64.05,73.98)%vs.66.70(60.36,72.85)%,P=0.009]in ApHCM patients.The incidence of adverse outcomes was lower in ApHCM patients during hospitalization.Conclusions Compared to classic HCM patients,ApHCM patients are typically older at diagnosis,have less positive HCM family history,lower brain natriuretic peptide level,more likely to have LVHV,T wave inversion,better cardiac function,and better prognosis.