Deterministic assessment of the risk of sudden death in hypertrophic cardiomyopathy

摘要

Over the course of a long-term follow-up, ranging from 1 to 24 years, data regarding syncope, chest pain, palpitations, dyspnea on exertion, the presence of the disease in other family members, electrocardiographic and echocardiographic changes and the risk of sudden death among patients with hypertrophic cardiomyopathy were prospectively collected. one hundred and twenty-five patients were included in the study (78 men and 47 women). Their mean age was 41 years (±12). Twenty patients (16%) died suddenly during the study. Deterministic analysis, using the method of rough-sets theory, showed common electrocardiographic and echocardiographic features for all the patients who died suddenly. Electrocardiographic features indicative of the risk of sudden death are different for different types of hypertrophy. type II hypertrophy, the risk of sudden death exists when the ECG demonstrates either right ventricular hypertrophy or P mitrale in the absence of pathological anterior Q waves and bundle branch block, or when anterior Q waves, RVH, and P mitrale occur simultaneously in the absence of bundle branch block. For type III hypertrophy, the risk of sudden death exists when the ECG presents no more than one of the three following features: anterior Q waves, right ventricular hypertrophy or P mitrale, in the absence of bundle branch block or when anterior Q waves, RVH and P mitrale (all three features) occur simultaneously in the absence of bundle branch block.In both types (II and III) of hypertrophy, however the risk of sudden death can also exist when none of the above mentioned changes (pathological anterior Q waves, right ventricular hypertrophy, P mitrale and bundle branch block) occurs. In patients with type IV hypertrophy we found the risk of sudden death to be low. There are common electrocardiographic and echocardiographic features characteristic for all the patients with hypertrophic cardiomyopathy who die suddenly. These risk factors of sudden death exist innearly 60% patients with hypertrophic cardiomyopathy.