| Objective: A retrospective analysis of 283 cases of hypertrophic cardiomyopathy during period of hospitalization,and then analyzing the data of the follow-up for the patients with HCM.in order to understand the clinic features of local HCM,and to guide the clinical treatment,to improve the quality of life and clinical symptoms and the prognosis and prevention of sudden death in HCM patients.Methods: The clinical data of 283 hypertrophic cardiomyopathy patients come from West China Hospital Department of Cardiovascular Diseases of Sichuan University from January2009 to December 2015 which were retrospectively analyzed.The data included geographical distribution,age,gender,habits,concomitant diseases,disease duration,blood biochemical examination,admission UCG,ECG,dynamic electrocardiogram and coronary angiography results,medication,interventional therapy,surgical treatment and follow-up survival in univariate analysis,the cause of death analysis.Results:(1)the age range of onset: 283 cases of hypertrophic cardiomyopathy,the age of onset is 12~86 years old,the average age is 52.09±16.11 years old,the average age of men is 50.09±15.30 years,and the average age of women is 54.47±16.70 years.Age ratio of less than 20 years in 12 cases(4.24%),more than 80 years of age in 3 cases(1.06%),21~40 years of 48 cases(16.96%),41~60 years of 127 cases(44.88%),61~80 years of 93 cases(32.86%).(2)the proportion of sex: 154 male cases-7-(54.4%)of 283 cases of hypertrophic cardiomyopathy were higher than that of women in 129 cases(45.6%).(3)family history: 8.48% of the 283 patients in this group had a family history of hypertrophic cardiomyopathy.There were 10 cases of sudden death in the family of 283 cases.(4): the common clinical symptoms of 283 cases with HCM included chest pain in 168 cases(59.36%),palpitation in 117 cases(41.34%),dyspnea in 169 cases(59.72%),Amaurosis syncope in 108 cases(38.16%).The dyspnea and palpitation was more commom in the female than male patients(P=0.004)(P=0.019).There was no difference between male and female patients with chest pain(P=0.730).The syncope and amaurosis proportion didn't significant differences in the male and female patients with HCM(P=0.850).(5)Concomitant diseases:The concomitant diseases included hypertension,74 cases(26.15%),cerebral infarction 3 cases(1.06%),diabetes mellitus 15 cases(5.30%),coronary heart disease 6 cases(2.12%),1 cases(0.35%)of infective endocarditis,13cases(4.59%)of pulmonary infection,6 cases(2.12%)of chronic obstructive pulmonary disease,1 cases(0.35%)of pulmonary heart disease;inpatient hospital during cardiopulmonary resuscitation in 5 cases(1.77%),with atrial septal defect in 2 cases(0.71%),and patent foramen ovale in 2 cases(0.71%),complicated with sleep apnea syndrome in 2 cases(0.71%),hypothyroidism in 4cases(1.41%),2 cases(0.71%)with multiple myeloma,4 cases(1.41%)with anemia,1 cases(0.35%)of liver cirrhosis,with low protein in 1 cases(0.35%),1 cases(0.35%)with thyroid cancer,1 cases(0.35%)with nephrotic syndrome,and bronchiectasis with infection in 1 cases(0.35%),2 cases(0.71%)with-8-pericardial effusion in 283 cases of hypertrophic cardiomyopathy.Hypertrophic cardiomyopathy combined with hypertension in male was higher than that of famale(P=0.048),and the proportion of diabetes in women was higher than that of men(P=0.027).(6)117 cases(41.34%)showed obstruction of the outflow tract in the 283 cases with HCM.56 cases(19.79%)of male obstructive HCM,98 cases(34.63%)of male non obstructive HCM patients,61cases(21.55%)of female obstructive HCM patients,and 68(24.03%)cases of non obstructive HCM patients.(7)electrocardiogram and dynamic electrocardiogram:ECG examination was mainly sinus rhythm,89.05% of the patients with conventional 12 lead ECG are sinus rhythm,23 cases(8.13%)showed persistent atrial fibrillation,and the incidence of male atrial fibrillation was higher than that of female.Pathological Q wave changes in 55 cases(19.43%),abnormal Q wave was a common electrocardiogram change in hypertrophic cardiomyopathy.15 cases(5.30%)showed the ST-T change.Atrial arrhythmia and ventricular arrhythmia were most common in the dynamic electrocardiogram,including 77 cases(27.21%)of atrial arrhythmia and ventricular arrhythmia in 131 cases(46.29%).(8)According to echocardiography 283 cases of hypertrophic cardiomyopathy hypertrophy were constituted of ventricular septal thickening,the proportion was 86.93%,the apical hypertrophy was about 6.00%,the proportion of left ventricular posterior wall hypertrophy was about 4.59%,and the proportion of ventricular septal and left ventricular posterior wall hypertrophy was about 2.47%.The pressure order difference of left ventricular outflow tract was greater than 50 mm Hg in 117-9-cases(41.34%).(9)The results of coronary angiography showed : Coronary angiography was performed in 101 patients.No abnormal coronary artery was found in 71 patients.6 cases of coronary artery disease were diagnosised.The incidence was 2.12%.Only 2 patients underwent coronary CABG.(10)blood biochemical examination: 283 cases of hypertrophic cardiomyopathy,the average value of uric acid was 409.99±106.11umol/L,and the average value of female was 356.37±245.85umol/L,which was significantly higher in males than in females.The overall pro-BNP value increased,but the average pro-BNP value of women was higher than that of the male.The higher the admission and discharge pro-BNP,the worse the prognosis.The average value of the whole serum calcium male was 2.21±0.21mmol/L,and the average female was 2.23±0.12mmol/L.The patient's with the serum calcium less than 2.2mmol/l.presented bad prognosis.(11)interventional and surgical treatment: In 283 cases of hypertrophic cardiomyopathy,31 cases(10.95%)of patients with hypertrophic obstructive cardiomyopathy underwent ventricular septal alcohol ablation,which reduced ventricular septal thickness and left ventricular outflow tract pressure gradient,and improved the clinical symptoms after operation.There were 46 cases(16.25%)underwent permanent pacemaker,with permanent pacemaker placement ICD cases were the most,a total of 29 cases(10.25%).10 cases(3.53%)of DDD patients were implantated by permanent pacemaker implantation.5cases(1.77%)were accepted VVI pacemaker,2cases(0.71%)were accepted CRTD.Radiofrequency ablation was performed in2 patients(0.71%)with atrial fibrillation and ventricular tachycardiarespectively.A total of 6 cases(2.12%)underwent surgical operation.2 patients(0.71%)accepted CABG.(12)medcine treatment: 233 patients(82.33%)received beta blocker therapy.6.36% patients were treated with non-twohydropyridine calcium antagonists.2.12% with ventricular or supraventricular arrhythmia received amiodarone.By the Kaplan-Meier to estimate the survival curve,the patients with accepting beta blocker treatment showed the longer survival time.(13)follow up analysis: 283 cases were followed 36±10 months.The resulted showed 24 cases of HCM died from HCM,and the smoking was a risk factor.The history of cardiopulmonary resuscitation(CPR)during hospitalization was a risk factor(P=0.000).The patients continued to receive beta blocker therapy had a better prognosis(P=0.021),the beta blocker is a protective factor,adhere to the oral beta blocker longer survival time,P=0.006<0.05.The results showed that blood calcium is a protective factor.The patients with the serum calcium less than 2.2mmol/l.presented bad prognosis.The survival time of patients with pro-BNP more than 10000pg/ml were shorter than the pro-BNP less than 10000pg/ml(P=0.007).The survival time of the patients with septal hypertrophy and LVPW thickness higher than 13 mm was shorter than the other patients in the 283 cases.The survival time in the group of smoking was shorter than the non smoking group.The patients with CPR history during hospitalization showed shorter survival time than other patients with out CPR history.The survival rhythm of ECG was compared with the baseline rhythm of patients.the survival time of the patients with Sinus rhythm-11-w as the longest than other rhythm(P=0.04).Conclusion: 1.The research results suggests that the age of onset of HCM is more than 40~70 years old,and the age of women is later than that of men.The incidence of male(54.42%)is higher than that of female(45.58%).Obstructive HCM is accounting for41.34%,non obstructive HCM is accounting for 58.66%,and there is no difference in the proportion of obstructive HCM in male and female.The common symptoms of the patients with HCM have chest tightness,chest pain,shortness of breath,palpitation,dyspnea,syncope.Chest pain(59.36%),shortness of breath(59.72%)is the most common.The symptoms of palpitation usually onset in women.The patients with HCM can be combined with hypertension and coronary heart disease.2.Electrocardiogram(ECG)is lack of specificity for HCM diagnosis,but its sensitivity is high,because of detecting abnormal electrocardiogram ahead of clinical symptom.Dynamic electrocardiogram(Holter)is of great significance for early detection of malignant arrhythmia,such as asymptomatic ventricular tachycardia and the causes of palpitation and syncope.Color Doppler echocardiography is still the main detection method for the diagnosis of HCM.But for patients who are undiagnosed with color Doppler echocardiography and patients with high degree of suspicion of apical hypertrophy,cardiac MRI can be considered.Cardiac magnetic resonance imaging also has an advantage in the discovery of myocardial fibrosis.3.treatment of the patients with HCM should follow the principle of individualization and the HCM guide to choose reasonable medicine,intervention or surgical treatment method.4.Factors affecting theprognosis:(1)The long-term standardized use of beta blockers result in longer survival time and better prognosis of patients.(2)Smoking is one of the risk factors that affect the survival time of HCM patients.(3)the study is showing that the patient's with serum calcium less than 2.2mmol/l present shorter survival time.(4)The history of cardiopulmonary resuscitation(CPR)is one of the risk factors for survival.(5)The elevation of Pro-BNP indicates poor prognosis.(6)HCM patients with atrial fibrillation and no left atrial dilatation and without severe intolerance to antiarrhythmic drugs or drug therapy,may receive atrial fibrillation ablation.(7)The prognosis of the patients with ventricular septum and left ventricular posterior wall hypertrophy is poor and the survival time is shorter.In especial,patients with ventricular septum hypertrophy and LVPW>13mm have more poor prognosis. |
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