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目的关于左室致密化不全(left ventricular non-compaction,LVNC)的临床研究较少,本研究的旨在评估老年患者的临床特点和预后。方法前瞻性连续入选2008年至2014年在阜外医院经心脏核磁共振(cardiac magnetic resonance,CMR)确诊为LVNC的老年患者(年龄兰60岁)。结果研究共入选32例患者(年龄65±5岁,男性占75%)。心脏超声未确诊的有12例(38%)。在接受冠脉影像评估的18例患者中,6人(33%)合并冠心病。无合并先天性心脏病和预激综合征的患者。有3例患者失访。对余29人随访期间(3.0±2.1年),9例(31%)患者死亡。Cox生存分析显示既往有晕厥史(HR:21.04;CI:1.78-248.78;P=0.02)、左室舒张末期内径增大(HR:1.13:CI:1.01-1.24;P=0.03)、左室射血分数下降(HR:0.87;CI:0.78-0.98;P=0.02)、存在钆对比剂延迟强化(HR:7.70;CI:1.14-73.08;P=0.04)是患者死亡的危险因素。结论老年LVNC在超声检查时具有较高的误诊率。冠心病在老年患者中较常见,而先天性心脏病和预激综合征少见。老年IVNC患者有较高的死亡率。
Objective There are few clinical studies on left ventricular non-compaction (LVNC). The aim of this study was to evaluate the clinical features and prognosis of elderly patients. Methods A prospective, consecutive prospective cohort of elderly patients (age 60 years) with LVNC diagnosed by cardiac magnetic resonance (CMR) at Fu Wai Hospital from 2008 to 2014 was prospectively selected. Results The study enrolled 32 patients (age 65 ± 5 years, men 75%). Echocardiography was not diagnosed in 12 cases (38%). Of the 18 patients evaluated by coronary angiography, 6 (33%) had coronary heart disease. No patients with congenital heart disease and Wolff-Parkinson’s syndrome. Three patients were lost. During the 29 follow-up visits (3.0 ± 2.1 years), 9 (31%) patients died. Cox survival analysis showed a history of syncope (HR: 21.04; CI: 1.78-248.78; P = 0.02), increased left ventricular end-diastolic diameter (HR: 1.13: CI: 1.01-1.24; (HR: 0.87; CI: 0.78-0.98; P = 0.02). Delayed enhancement of gadolinium contrast agent (HR: 7.70; CI: 1.14-73.08; P = 0.04) was a risk factor for death in patients. Conclusion LVNC in elderly patients has higher misdiagnosis rate in ultrasound examination. Coronary heart disease is more common in elderly patients, and congenital heart disease and pre-excitation syndrome rare. Elderly IVNC patients have a higher mortality rate.