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Hypertrophic Cardiomyopathy in "Real-World" Community Cardiology Practice.

“真实世界” 社区心脏病学实践中的肥厚型心肌病。

  • 影响因子:2.86
  • DOI:10.1016/j.amjcard.2020.01.040
  • 作者列表:"Rowin EJ","Maron MS","Bhatt V","Gillam L","Maron BJ
  • 发表时间:2020-05-01
Abstract

:Differences in presentation and natural history of hypertrophic cardiomyopathy (HC) between community cardiology practice and referral centers has been a source of considerable uncertainty. We report here a cross-sectional analysis of 253 consecutive HC patients from a "real-world" clinical cardiology setting. When compared with a highly selected referral center cohort, patients in clinical practice proved to be similar with regard to disease expression such as left ventricular (LV) wall thickness, outflow obstruction, and natural history, including stable and largely benign clinical course with no or mild symptoms (61% in community practice vs. 55% in referred patients, p = 0.23), occurrence of atrial fibrillation (22% vs. 24%, p = 0.75) and nonfatal sudden death (SD) events (3% vs. 4%, p = 0.8). In contrast, progressive heart failure symptoms were most common in the referral cohort (36% vs. 26%, p = 0.04). In clinical practice, SD was prevented by prophylactic implatable cardioverter defibrillators (ICD) in 5 of 44 patients (11%), although risk was overestimated in 6 patients who were implanted with ICDs in the absence of risk markers (14%). In 16 of 61 (26%) severely symptomatic drug-refractory patients with LV outflow obstruction, recommendation for surgical myectomy (or alcohol septal ablation) was delayed. In conclusion, clinical characteristics and course of HC patients in community practice were generally similar to those in HC referral centers. Community cardiologists managed HC patients predominantly in concert with guideline-based strategies, although risk for SD could be overestimated, and the significance of outflow obstruction with timely reversal of refractory heart failure by intervention was underappreciated.

摘要

: 社区心脏病学实践和转诊中心之间肥厚型心肌病 (HC) 的表现和自然史的差异是相当大的不确定性的来源。我们在这里报告了来自 “真实世界” 临床心脏病学环境的253例连续HC患者的横断面分析。当与高度选择的转诊中心队列相比时,临床实践中的患者被证明在疾病表达方面相似,例如左心室 (LV) 壁厚度,流出道梗阻和自然史,包括稳定且基本上良性的临床过程,没有症状或轻微症状。(61% 社区实习vs. 55%,转诊病人,p  =   0.23),发生心房颤动 (房颤),差异有统计学意义 (22% vs. 24%,p  =   0.75) 和非致死性猝死 (SD) 事件 (3% 比4%,p  =   0.8).相反,在转诊队列中,进行性心力衰竭症状最常见 (36% 对26%,p = 0.04)。在临床实践中,预防性心脏复律除颤器 (ICD) 预防了44例患者中的5例 (11%) 的SD,尽管在没有风险标记的情况下植入ICD的6例患者 (14%) 的风险被高估。在61例严重有症状的药物难治性LV流出道梗阻患者中,16例 (26%) 延迟了手术肌切除术 (或酒精间隔消融术) 的建议。总之,社区实践中HC患者的临床特征和病程与HC转诊中心相似。社区心脏病专家主要根据基于指南的策略管理HC患者,尽管SD风险可能被高估,并且通过干预及时逆转难治性心力衰竭的流出道梗阻的重要性被低估.

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心脏瓣膜病方向

人的心脏有四个瓣膜,分别为二尖瓣、三尖瓣、主动脉瓣和肺动脉瓣。心脏瓣膜病就是指二尖瓣、三尖瓣、主动脉瓣和肺动脉瓣的瓣膜因风湿热、黏液变性、退行性改变、先天性畸形、缺血性坏死、感染或创伤等出现了病变,影响血流的正常流动,从而造成心脏功能异常,最终导致心力衰竭的单瓣膜或多瓣膜病变。随着人口老龄化加重,老年性瓣膜病以及冠心病、心肌梗死后引起的瓣膜病变也越来越常见。

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