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Frequency and Significance of Coronary Artery Disease and Myocardial Bridging in Patients With Hypertrophic Cardiomyopathy.

肥厚型心肌病患者冠状动脉疾病和心肌桥的频率和意义。

  • 影响因子:2.86
  • DOI:10.1016/j.amjcard.2020.02.002
  • 作者列表:"van der Velde N","Huurman R","Yamasaki Y","Kardys I","Galema TW","Budde RP","Zijlstra F","Krestin GP","Schinkel AF","Michels M","Hirsch A
  • 发表时间:2020-05-01
Abstract

:The etiology of chest pain in hypertrophic cardiomyopathy (HC) is diverse and includes coronary artery disease (CAD) as well as HC-specific causes. Myocardial bridging (MB) has been associated with HC, chest pain, and accelerated atherosclerosis. We compared HC patients with age-, gender- and CAD pre-test probability-matched outpatients presenting with chest pain to investigate differences in the presence of MB and CAD using coronary computed tomography angiography (CCTA). We studied 84 HC patients who underwent CCTA and compared these with 168 matched controls (age 54 ± 11 years, 70% men, pre-test probability 12% [5% to 32%]). MB, calcium score, plaque morphology and presence and extent of CAD were assessed for each patient. Linear mixed models were used to assess differences between cases and controls. MB was more often seen in HC patients (50% vs 25%, p <0.001). Calcium score and the presence of obstructive CAD were similar in both groups (9 [0 to 225] vs 4 [0 to 82] and 18% vs 19%; p = 0.22 and p = 0.82). In the HC group, MB was associated with pathogenic DNA variants (p = 0.04), but not with the presence of chest pain (74% vs 76%, p = 0.8), nor with worse outcome (log-rank p = 0.30). In conclusion, the prevalence and extent of CAD was equal among patients with and without HC, demonstrating that pre-test risk prediction using the CAD Consortium clinical risk score performs well in HC patients. MB was twice as prevalent in the HC group compared with matched controls, but was not associated with chest pain or decreased event-free survival in these patients.

摘要

肥厚型心肌病 (HC) 胸痛的病因是多种多样的,包括冠状动脉疾病 (CAD) 以及HC特异性病因。心肌桥 (MB) 与HC、胸痛和加速动脉粥样硬化有关。我们比较了年龄、性别和CAD测试前概率匹配的门诊患者,这些患者表现为胸痛,以使用冠状动脉计算机断层扫描血管造影术 (CCTA) 研究MB和CAD存在的差异。我们研究了84例接受CCTA的HC患者,并将其与168例匹配的对照 (年龄54 ± 11岁,70% 例男性,测试前概率12% [5% ~ 32%]) 进行了比较。对每个患者的MB、钙评分、斑块形态以及CAD的存在和程度进行评估。使用线性混合模型来评估病例和对照之间的差异。MB多见于HC患者 (50% vs 25%,p <0.001)。两组的钙评分和阻塞性CAD的存在相似 (9 [0 ~ 225] vs 4 [0 ~ 82] 和18% vs 19%; P   =   0.22和p   =   0.82)。HC组,MB与致病性DNA变体 (p  =   0.04),而与存在胸痛 (74% vs 76%,p  =   0.8),也与不良预后 (log-rank p  =   0.30).总之,在有HC和没有HC的患者中,CAD的患病率和程度是相等的,这表明使用CAD联盟临床风险评分的测试前风险预测在HC患者中表现良好。与匹配的对照组相比,MB在HC组中的发生率是对照组的两倍,但与这些患者的胸痛或无事件生存率降低无关。

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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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