ハイパルトロフィック心筋病変症では昏睡と突然死のリスクがあります
Paolo Spirito1, Camillo Autore, Claudio Rapezzi
1Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera, Via Volta 8, Genova 16128, Italy. paolo.spirito@galliera.it
Circulation
|March 25, 2009
まとめ
ハイパートロフィック心筋症の患者の原因不明のは,突然死のリスク要因であり,特に評価のすぐ近くに発生した場合です. 高齢の患者の遠隔失眠は,このリスクを増加させません.
科学分野:
- 心臓病学 心臓病学
- クリニカル・メディシン 臨床医学
- 心臓発作による突然死.
背景:
- ハイパートロフィック心筋病症 (HCM) のシナコープの予後的意義は十分に研究されていない.
- 現在,シンコープに対するHCM治療戦略は,証拠ではなく経験に基づいています.
研究 の 目的:
- HCM患者の大規模なコホートで昏睡と突然死との関係を調査する.
- HCMにおける突然死のリスクの増加と関連したシンコープ特性を特定する.
主な方法:
- 連続した1511人のHCM患者で昏睡と突然死が評価されました.
- 原因不明または神経媒介性として分類された.
- 突然死のリスク要因を決定するために多変量分析を利用し,昏睡の時間的近さに焦点を当てました.
主要な成果:
- 原因不明のは14%の患者で,神経媒介によるは3.4%の患者で発生した.
- 原因不明のシンコペは突然死のリスクの増加傾向を示した (RR 1.78,P=0.08).
- 評価から6カ月以内の昏睡は,特に若い患者において,突然死のリスク (AHR4.89) を著しく増加させた. 高齢の患者における遠隔シンコップは,リスクを高めることはありませんでした.
結論:
- 原因不明の (syncope) は,高縮性心筋病変において突然死を引き起こす重大な危険因子である.
- 臨床評価に照らし合わせた原因不明のシンコパ・イベントのタイミングは,リスクの階層化に極めて重要です.
- リモートシンコープエピソードを持つ高齢のHCM患者は,突然死のリスクが増加していない.
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