肥厚型心肌病猝死危险因素的影像学评估进展

doi:10.3877/cma.j.issn.1672-6448.2023.08.014

肥厚型心肌病（hypertrophic cardiomyopathy，HCM）是临床常见的遗传性心肌病，患病率为1/500~1/200，其临床表现具有高度异质性，部分患者首发症状即为猝死。心脏性猝死（sudden cardiac death，SCD）是HCM最严重的并发症，发生率约为1%，HCM导致的猝死是年轻人和运动员发生SCD的首要原因。识别SCD危险因素，筛查潜在的高危患者，是HCM危险分层的重要内容。2014年《欧洲心脏病学会指南》指出SCD的危险因素的影像学指标包括最大室壁厚度、左心房大小和左心室流出道梗阻，并推荐采用5年猝死评分对HCM患者SCD风险进行个体化分层评估。2017年《中国肥厚型心肌病诊断与治疗指南》采纳了2014年指南的HCM预测模型，并增加了心脏磁共振（cardiac magnetic resonance，CMR）的轧延迟增强（late gadolinium enhancement，LGE）作为预测指标。2020年《美国心脏协会/美国心脏病协会指南》在此基础上又新增了左心室心尖室壁瘤（left ventricular apical aneurysm，LVAA）、左心室收缩功能障碍等影像学指标作为SCD危险因素。指南中关于上述危险因素的描述多较为简略，并且近年来又发现多个与SCD相关的影像学参数，虽未被纳入指南，但同样值得大家关注。因此，现就SCD危险因素相关影像学参数的研究进展做一综述。

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