室间隔酒精消融术后左心室流出道压差下降幅度及影响因素分析

张勇; 刘小燕; 成小凤; 李平; 何永铭; 陈佳; 夏红梅; 徐亚丽; 王江

doi:10.16016/j.1000-5404.201910112

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室间隔酒精消融术后左心室流出道压差下降幅度及影响因素分析

临床医学 | 更新时间：2026-01-09

- 室间隔酒精消融术后左心室流出道压差下降幅度及影响因素分析
- Decreasing amplitude of left ventricular outflow tract gradient and its influencing factors after alcohol septal ablation
- 第三军医大学学报 2020年42卷第5期页码：499-503
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院心血管内科，全军心血管病研究所
- 作者简介：
  
  [王江，E-mail: 1530579054@qq.comANG Jiang, E-mail: 1530579054@qq.com
- 基金信息：
  
  陆军军医大学第二附属医院临床科研课题(2015LCXJS029);第三军医大学新桥医院临床科研项目(2014YLC12)
- DOI：10.16016/j.1000-5404.201910112
  中图分类号： R540.46;R542.2;R914.4
- 收稿：2019-10-17，
  
  修回：2020-01-01，
  
  纸质出版：2020-03-15
- 稿件说明：
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张勇, 刘小燕, 成小凤, 等. 室间隔酒精消融术后左心室流出道压差下降幅度及影响因素分析[J]. 第三军医大学学报, 2020,42(5):499-503.

Yong ZHANG, Xiaoyan LIU, Xiaofeng CHENG, et al. Decreasing amplitude of left ventricular outflow tract gradient and its influencing factors after alcohol septal ablation[J]. Journal of Third Military Medical University, 2020, 42(5): 499-503.
张勇, 刘小燕, 成小凤, 等. 室间隔酒精消融术后左心室流出道压差下降幅度及影响因素分析[J]. 第三军医大学学报, 2020,42(5):499-503. DOI： 10.16016/j.1000-5404.201910112.

Yong ZHANG, Xiaoyan LIU, Xiaofeng CHENG, et al. Decreasing amplitude of left ventricular outflow tract gradient and its influencing factors after alcohol septal ablation[J]. Journal of Third Military Medical University, 2020, 42(5): 499-503. DOI： 10.16016/j.1000-5404.201910112.

摘要

目的

观察室间隔酒精消融术(alcohol septal ablation，ASA)治疗肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy，HOCM)后左心室流出道压差(left ventricular outflow tract gradient，LVOTG)的下降幅度，并分析其影响因素。

方法

收集本院2011年8月至2019年8月行ASA治疗的HOCM患者58例，比较手术前后超声心动图的变化(中位随访34 d)，评估术后LVOTG的下降幅度。根据LVOTG是否降低50%分为LVOTG下降显著组(LVOTG下降≥50%)及不显著组(LVOTG下降＜50%)，对比两组患者的临床资料，分析LVOTG下降显著的独立影响因素，并对影响因素作ROC曲线分析。

结果

58例患者ASA术后LVOTG为(46.13±39.31)mmHg，较术前(90.77±33.38)mmHg显著下降(

0.05)，术后室间隔厚度、左房内径、二尖瓣反流面积、二尖瓣收缩期前向运动征均显著减少(

0.05)。多因素logistic回归分析显示，酒精剂量(

3.222，95%

:1.345~7.717，

=0.009)是短期LVOTG下降显著的独立影响因素，ROC曲线下面积(AUC)为0.707(95%

:0.573~0.841，

=0.009)。

结论

ASA可有效降低HOCM患者的LVOTG，接受高剂量酒精消融的患者LVOTG下降的幅度更显著。

Abstract

Objective

To analyze the decreasing amplitude of left ventricular outflow tract gradient(LVOTG) and its influencing factors after alcohol septal ablation(ASA) in treatment of hypertrophic obstructive cardiomyopathy(HOCM).

Methods

A total of 58 HOCM patients treated by ASA in our hospital from August 2011 to August 2019 were recruited in this study. The changes of echocardiography before and after ASA(a median follow-up period of 34 d) were compared to evaluate the decreasing amplitude of LVOTG after surgery. According to whether the LVOTG was decreased by 50%

the patients were divided into the significant LVOTG decline group(LVOTG decline ≥50%) and the non-significant decline group(LVOTG decline < 50%). The clinical data were compared between the 2 groups. The independent influential factors of significant LVOTG decline were analyzed

and receiver operation characteristic(ROC) curve analysis was also performed for the influencing factors.

Results

The LVOTG of the 58 patients was decreased from 90.77±33.38 mmHg preoperatively to 46.13±39.31 mmHg(

0.05). The interventricular septum thickness

left atrial diameter

mitral regurgitation area and systolic anterior motion were all significantly reduced after surgery (

0.05). Multivariate logistic regression analysis indicated that alcohol dose(

=3.222

95%

: 1.345~7.717

=0.009) was an independent influencing factor of significant LVOTG decline in short term

with the area under curve(AUC) of 0.707(95%

: 0.573~0.841

=0.009).

Conclusion

ASA can effectively reduce LVOTG in HOCM patients. And the higher the alcohol dose is

the more significant the decreasing amplitude is.

关键词

Keywords

references

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