Distance Between the Anterior Papillary Muscle and Interventricular Septum Evaluated by Echocardiography to Diagnose Midventricular Obstruction in Hypertrophic Cardiomyopathy.

IF 5.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Minghu Xiao, Jingjin Wang, Changrong Nie, Changsheng Zhu, Xin Sun, Yanhai Meng, Zhenhui Zhu, Hao Wang, Shuiyun Wang
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引用次数: 0

Abstract

Background: Left ventricular midventricular obstruction (MVO) is thought to be dynamic with hypertrophic cardiomyopathy (HCM). Therefore, the distance between the anterior papillary muscle (APM) and the interventricular septum (IVS) was used to assess MVO on rest echocardiography.

Methods: MVO was defined as a midventricular gradient of ≥30 mm Hg at rest or after being provoked. APM-IVS distance was analyzed in the apical three-chamber view at end-diastole.

Results: A total of 2,125 patients with HCM were enrolled in this study. Among these, data from 1,453 patients with measurable APM-IVS distances were analyzed. Of the 1,453 patients, 596 had MVO, while 857 did not exhibit MVO. Multivariate logistic regression analyses showed that APM-IVS distance was an independent indicator of MVO (adjusted odds ratio, 0.487; 95% CI, 0.448-0.529). APM-IVS distance demonstrated the highest diagnostic accuracy in identifying MVO, exhibiting an area under the receiver operating characteristic curve of 0.949 (95% CI, 0.937-0.960). The presence of a smaller APM-IVS distance was correlated with increased incidence of left ventricular apical aneurysm and MVO, elevated levels of N-terminal pro-brain natriuretic peptide, and higher New York Heart Association functional class. Among patients with MVO, 198 underwent surgical myectomy and were followed up after a median time of 12 months. APM-IVS distance increased from 7.6 ± 2.2 to 18.9 ± 4.9 mm, and the peak midventricular gradient decreased from 50 mm Hg (36-57 mm Hg) to 3 mm Hg (3-7 mm Hg) at follow-up.

Conclusions: A small APM-IVS distance was associated with MVO, which was alleviated after myectomy following an increase in APM-IVS distance.

超声心动图评价肥厚性心肌病前乳头肌与室间隔距离诊断中室间隔梗阻的价值。
背景:左室中室梗阻(MVO)被认为是肥厚性心肌病(HCM)的动态症状。因此,静息超声心动图以前乳头肌与室间隔的距离作为评价MVO的参数,命名为APM-IVS距离。方法:MVO定义为静息或刺激后心室中梯度≥30 mmHg。舒张末期顶点三腔镜下APM-IVS距离分析。结果:共有2125例HCM患者纳入本研究。其中,分析了1453例APM-IVS距离可测量患者的数据。在1453例患者中,596例有MVO, 857例无MVO。多因素logistic回归分析显示,APM-IVS距离是MVO的独立指标(校正优势比[95%可信区间(CI)]: 0.487[0.448-0.529])。APM-IVS距离对MVO的诊断准确率最高,在受试者工作特征曲线下的面积为0.949 (95% CI: 0.937 ~ 0.960)。APM-IVS距离较短与左室顶动脉瘤和MVO发生率增加、n端前脑利钠肽水平升高以及纽约心脏协会功能分级升高相关。在MVO患者中,198例患者接受了子宫肌瘤切除术,中位随访时间为12个月。APM-IVS距离从7.6±2.2 mm增加到18.9±4.9 mm,中心室梯度峰值从50 mmHg (36-57 mmHg)下降到3 mmHg (3-7 mmHg)。结论:较小的APM-IVS距离与MVO相关,随着APM-IVS距离的增加,MVO在肌瘤切除术后得到缓解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
9.50
自引率
12.30%
发文量
257
审稿时长
66 days
期刊介绍: The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.
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