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目的探讨NYHA心功能分级与肥厚型心肌病(HCM)患者预后的相关性,发现可用于患者分层的危险因素。方法从1999年到2000年,前瞻性纳入16岁在中国医学科学院阜外医院就诊的16岁以上成年HCM患者。记录基线临床信息并定期随访,建立HCM队列。HCM患者按入组时是否达到美国纽约心脏病协会(NYHA)分级Ⅲ/Ⅳ级分为2组,比较基线临床表型和临床结局。结果本研究共纳入成年HCM患者523例,其中入组时NYHA心功能Ⅲ/Ⅳ级患者63例(12.0%)。NYHA心功能Ⅲ/Ⅳ组患者中女性比例显著高于男性,心率更快,左房内径更大,射血分数更低,伴有Q波异常的比例更高,携带心源性猝死(SCD)为传统危险因素的比例更高。在平均4.7±3.2年的随访过程中,共发生死亡44例,其中心血管死亡40例。心功能Ⅲ/Ⅳ级患者发生全因死亡和心血管死亡的风险分别是其他患者的4.7倍(95%CI 2.54-8.69,P=1×10-6)和5.5倍(95%CI 2.92-10.35,P<1×10-8),独立于其他危险因素。死亡原因分析发现,心功能Ⅲ/Ⅳ级患者的SCD(校正后HR 4.21,95%C11.53 to 11.59,P=0.005)和因心衰死亡风险(校正后HR 6.99,95%CI 2.66 to 18.35,P=8×10-5)均显著增加。结论 NYHA心功能分级与HCM患者预后显著相关,NYHA心功能Ⅲ/Ⅳ级可以作为患者分层的危险因素。
Objective To investigate the relationship between the NYHA functional class and the prognosis of patients with hypertrophic cardiomyopathy (HCM) and to find out the possible risk factors for the stratification of patients. Methods From 1999 to 2000, we prospectively enrolled adult HCM patients over the age of 16 who were 16 years of age at Fu Wai Hospital, Chinese Academy of Medical Sciences. Record baseline clinical information and follow-up to establish HCM cohort. HCM patients according to whether the group entered the New York Heart Association (NYHA) grade Ⅲ / Ⅳ were divided into two groups, comparing the baseline clinical phenotype and clinical outcomes. Results A total of 523 adult HCM patients were enrolled in this study. Among them, 63 NYHA class Ⅲ / Ⅳ patients (12.0%) were enrolled in the study. The proportion of women with NYHA cardiac function III / IV was significantly higher than that of men with faster heart rate, larger left atrium diameter, lower ejection fraction, higher Q wave abnormalities, and sudden cardiac death (SCD) The proportion of traditional risk factors is higher. During an average of 4.7 ± 3.2 years of follow-up, 44 deaths occurred, of which 40 were cardiovascular deaths. The risk of all-cause and cardiovascular death in patients with grade III / IV cardiac function was 4.7-fold (95% CI 2.54-8.69; P = 1 x 10-6) and 5.5-fold (95% CI 2.92-10.35 , P <1 × 10-8), independent of other risk factors. Analysis of the cause of death found that SCD (corrected HR 4.21, 95% C 11.53 to 11.59, P = 0.005) and risk of heart failure due to heart failure (adjusted 6.99, 95% CI 2.66 to 18.35 , P = 8 × 10-5) increased significantly. Conclusions There is a significant correlation between NYHA functional classification and prognosis in patients with HCM. NYHA cardiac function Ⅲ / Ⅳ can be used as a risk factor for stratification in patients.