摘要
目的比较功能-解剖方法和超声心肌增强方法指导下经冠状动脉消融肥厚心肌(TASH)治疗肥厚型梗阻性心肌病的有效性和安全性。方法 72例药物治疗不佳的肥厚型梗阻性心肌病患者分别采用超声心肌增强(GⅠ,47例)和功能-解剖方法(GⅡ,25例)指导下的 TASH 治疗。通过对比治疗前后同位素心肌灌注显像、患者主观症状的改善,以及系列超声参数的变化评价不同方法指导下的 TASH 治疗效果和安全性。结果两种方法指导下的 TASH 均能显著降低患者左心室流出道的压力阶差,并显著改善患者主观症状,两组间差异无统计学意义。酒精用量、消融心肌范围、状态以及术后 CK-MB 峰值两组间差异无统计学意义。心律失常(包括右束支传导阻滞、室性心动过速/心室颤动和临时起搏器依赖)两组发生率相似。GⅠ有6例患者经 MCE 纠正初选血管(工作初期)。系列的超声心动图长期随访左心室构型变化二组患者间差异无统计学意义。结论 MCE 指导下的 TASH 治疗效应并不优于"功能法",也不能减少酒精的用量和心律失常并发症,但能有效避免无辜心肌损伤,尤其是开展此项工作的初期。
Objective To compare the safety and efficacy of myocardial contrast enhancement （MCE）-guided and anglo-pressure （AP）-guided transcoronary ablation of septal hypertrophy （TASH） for patients with hypertrophic obstructive cardiomyopathy （HOCM）. Methods TASH was performed under MGE-guide （n = 47, group Ⅰ ） or AP-guide （n = 25, group Ⅱ） for drug-refractory patients with HOCM. Myocardial perfusion imaging （MPI） data as well as other clinical data were compared. Results TASH both under MCE-guide or AP-guide resulted in similar and significant reduction of left ventricular outflow tract gradient （PG） and associated with significant symptom improvement （all P 〈 0. 001 ）. Dosage of ethanol use, peak-level of CK-MB and ablated myocardial area and incidence of arrhythemia were also similar between the two groups. Similar left ventricular/atrial dimension changes post TASH were observed in the 2 groups during follow-up. However, the first selected septal vessels were changed under MCE in 6 patients. Conclusions Our data demonstrated that the MCE-guided TASH was not superior to AP-guided TASH in safety and efficacy. However, MCE-guided TASH can avoid the misplace of ethanol to avoid innocent myocardial ablation.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2007年第6期540-543,共4页
Chinese Journal of Cardiology
关键词
心肌病
肥厚性
导管消融术
心肌声学造影
Cardiomyopathy, hypertrophic
Catheter ablation
Myocardial contrast enhancement
