冠状动脉迂曲与室间隔肥厚型心肌病患者不良预后的相关性分析

Correlation between coronary artery tortuosity and poor prognosis in patients with septal hypertrophic cardiomyopathy

目的:探讨室间隔肥厚型心肌病(HCM)患者中冠状动脉(冠脉)迂曲的发生率及其与不良预后的相关性。方法:本研究为回顾性队列研究。选取2017年12月1日至2021年6月10日在阜外华中心血管病医院和郑州大学人民医院住院的室间隔HCM患者,根据性别、年龄、有无高血压1∶1配对非HCM患者作为对照组。按照有无冠脉迂曲将室间隔HCM组分为冠脉迂曲组和非冠脉迂曲组。比较室间隔HCM组和对照组患者基线临床资料和冠脉造影结果,采用多因素logistic分析导致冠脉迂曲的危险因素。随访室间隔HCM患者至2022年7月1日,主要终点事件是恶性心律失常、缺血性卒中、全因死亡的复合终点,比较冠脉迂曲组和非冠脉迂曲组主要终点事件发病密度,采用Cox风险比例回归模型分析影响室间隔HCM患者终点事件的危险因素。结果:室间隔HCM组和对照组各156例患者,年龄均为(57.0±11.4)岁,两组女性各75例(48.1%)。室间隔HCM组冠脉迂曲发生率高于对照组(63.5%比36.5%, P<0.01),冠脉迂曲评分高于对照组( P<0.01)。多因素logistic回归分析结果显示室间隔HCM是导致冠脉迂曲的危险因素( OR=3.27,95% CI:2.02~5.29, P<0.01)。经过(2.5±1.2)年随访,室间隔HCM患者中,冠脉迂曲组主要终点事件发病密度高于非冠脉迂曲组( P=0.02),冠脉迂曲评分每升高1分增加室间隔HCM患者53%的主要终点事件风险( HR=1.53,95% CI:1.26~1.86, P<0.01)。 结论:室间隔HCM患者易伴发冠脉迂曲,且程度更重;冠脉迂曲是室间隔HCM患者出现不良事件的危险因素。

ObjectiveTo investigate the incidence of coronary artery tortuosity and its correlation with poor prognosis in patients with septal hypertrophic cardiomyopathy(HCM).MethodsThis was a retrospective cohort study.Patients with septal HCM who were hospitalized in Fuwai Central China Cardiovascular Hospital and Zhengzhou University People′s Hospital between December 1,2017 and June 10,2021 were selected.Non-HCM patients were matched by gender,age,and hypertension as control group.Septal HCM was divided into two groups based on the presence or absence of coronary artery tortuosity.Clinical baseline data and coronary angiography findings were compared using a multifactorial logistic analysis of the risk factors for coronary artery tortuosity.Patients were followed up until July 1,2022,with the primary outcome being the composite endpoint of malignant arrhythmia,ischemic stroke and all-cause death.Incidence densities were compared between the coronary artery tortuosity and non-coronary artery tortuosity groups of septal HCM patients.The Cox risk-ratio model was used to analyze risk factors for primary outcomes in septal HCM patients.ResultsThere were 156 patients in the septal HCM group and 156 patients in the control group,both aged(57.0±11.4)years,and 75(48.1%)were female.The incidence of coronary artery tortuosity was significantly higher in the septal HCM group than in the control group(63.5%vs.36.5%,P<0.01),and the coronary artery tortuosity score was also higher in the septal HCM group than in the control group(P<0.01).Multiple logistic regression analysis showed that septal HCM was a risk factor for coronary artery tortuosity(OR=3.27,95%CI:2.02-5.29,P<0.01).In the septal HCM patients,after(2.5±1.2)years of follow-up,the incidence density of primary outcome was significantly higher in the coronary artery tortuosity group than in the non-coronary artery tortuosity group(P=0.02),while each on-point in coronary artery tortuosity score increased the risk of primary outcome by 53%for septal HCM patients(HR=1.53,95%CI:1.26-1.86,P<0.01).ConclusionsPatients with septal HCM are more prone to suffer coronary artery tortuosity and suffer from it to a greater extent.Coronary artery tortuosity is an important risk factor for adverse events in patients with septal HCM.