人工知能を用いた肥大型心筋症患者の収縮能低下および拡張相移行への予測

2022 Fiscal Year Annual Research Report

• Project/Area Number: 21K08138
• Research Institution: Nippon Medical School
• Principal Investigator: 高野 仁司 日本医科大学, 医学部, 准教授 (90277533)
• Co-Investigator(Kenkyū-buntansha): 時田 祐吉 日本医科大学, 医学部, 講師 (20386189) ; 松田 淳也 日本医科大学, 医学部, 助教 (10714735)
• Project Period (FY): 2021-04-01 – 2023-03-31
• Keywords: 肥大型心筋症 / 心不全

Outline of Annual Research Achievements

Background: Some patients with hypertrophic cardiomyopathy (HCM) progress to the dilated phase of HCM (DHCM). We aimed to identify the predictive factors for the development of DHCM (left ventricular ejection fraction (LVEF) < 50%) or declined LV contraction (LVEF < 60%) in patients with HCM.
Methods: We analyzed the data of 291 patients who were enrolled in our hospital’s HCM registry. The patients were divided into three groups based on their LVEF at the end of the study (LVEF remained > 60%, LVEF 50-60%, and DHCM < 50%). We evaluated the predictive factors of LVEF less than 50% and 60%. We also looked at how percutaneous transluminal septal myocardial ablation (PTSMA) affected long-term systolic LV function and DHCM development.
Results: During the follow-up period (mean, 71.8 months), LVEF remained > 60% in 239 patients, fell within the range of 50%-60% in 33 patients, and declined below 50% in 19 patients. Multivariate analyses indicated baseline atrial fibrillation (AF), non-sustained ventricular tachycardia (NSVT), left ventricular diameter at end-systole (LVDs) and C-reactive protein (CRP) as the significant predictors of DHCM and reduced estimated glomerular filtration rate as a nearly significant predictor for the declined LV contraction. PTSMA, performed in 78 HCM patients, did not significantly affect the long-term LVEF changes or the development of DHCM.
Conclusion: We concluded that AF, NSVT, LVDs and CRP are significant predictors of DHCM development. However, a validation study with a larger population is warranted.