| Part I.Clinical characteristics of hypertrophic cardiomyopathy with or wihout left ventricular enlargementObjective:This study aims to discovery the clinical features of hypertrophic cardiomyopathy with or without enlarged left ventricle.Methods:According to the size of left ventricle,170 hypertrophic cardiomyopathy(HCM)patients were divided into enlarged left ventricle group and normal left ventricle group.Then the diagnostic age,sex,complications,electrocardiogram,symptoms,drug treatment and echocardiographic parameters were compared between the two groups.Patients with HCM were further divided into obstructive hypertrophic cardiomyopathy,septal hypertrophic cardiomyopathy and apical hypertrophic cardiomyopathy.Moreover,the septal hypertrophic cardiomyopathy and apical hypertrophic cardiomyopathy were divided into enlarged left ventricle(ELV)group and nonrmal left ventricle(NLV)group,and the above-mentioned comparison between them was performed,respectively.Results:(1)In all HCM patients,the incidence of end-stage HCM is 5.29%and that of left ventricular enlargement is 10.0%.(2)In patients with HCM and septal HCM,the proportion of males in the ELY group was significantly higher than that in the NLV group(P=0.06 and 0.028,respectively),(3)Among patients with HCM and septal HCM,the LVEF was significantly decreased in the ELV group when compared with the NLV group,accordingly,utilization rate of diuretics in the former was higher than the latter.(4)The pacemaker implantation rate in the ELV group was significantly higher than that in NLV group among all HCM patients(P=0.025).Among patients with septal HCM,implantation rate of implantable cardioverter-defibrillator(ICD)in the ELV group was also higher than the NLV group's(P=0.044).(5)The left atrial diameter(LAd),incidence of atrial fibrillation or ST-T change,utilization rate of angiotensin converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB)in the ELV group were all higher than those in the NLV group in apical HCM patients(P<0.05).Conclusion:The HCM patients with ELV are easier to develop into ES-HCM than those with NLV.And the ELV is more common in men than in women.The clinical features in different types of hypertrophic cardiomyopathy with enlarged left ventricle were dissimilar.Part ?.The effect of hypertension on cardiac structure and function in different types of hypertrophic cardiomyopathyObjectives:To detennine whether hypertension(HTN)affects cardiac structure and function in different types of HCM.Methods:Patients with obstructive HCM,septal HCM,and apical HCM were separated into hypertensive and non-hypertensive subgroups,then the diagnostic age,sex,duration of HTN and echocardiographic parameters at baseline and at follow-up were compared between the groups.Results:At follow-up,hypertensive obstructive HCM patients showed decrease in end-diastolic volume(from 93.87±26.08 mL to 79.06±20.07 mL,P =0.045)and in left ventricular end-diastolic diameter(from 45.00±5.32 mm to 41.83±4.58 mm,P =0.042).Non-hypertensive obstructive HCM patients showed decrease in maximum aortic velocity(from 2.01±0.53m/s to 1.28±0.25 m/s,P=0.011)and in aortic maximum pressure gradient(from 17.22±9.57 mm Hg to 6.79±2.44 mm Hg,P =0.03).Hypertensive apical HCM patients showed increase in end-diastolic volume(from 95.28±16.54 mL to 119.74±25.19 mL,P =0.016)and in left ventricular end-diastolic diameter(from 45.28±3.36 mm to 50.20±4.56 mm,P =0.007).Conclusions:HTN can affect left ventricular capacity in obstructive HCM and apical HCM,causing decrease in ventricular capacity in the former and increase in the latter;it has no significant effect on the size of left ventricular cavity in septal HCM.HTN can lead to a poor therapeutic effect on aortic flow rate and pressure gradient in obstructive HCM patients. |
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