玛伐凯泰治疗手术后梗阻性肥厚型心肌病1例并文献复习

Mavacamten for the treatment of postoperative obstructive hypertrophic cardiomyopathy: a case report and literature review

  • 摘要: 肥厚型心肌病(HCM)是全球心血管疾病的重要致病类型,严重威胁人类健康。HCM患者临床症状变异性大,有些患者可长期无症状,而有些患者首发症状就是猝死,心脏性猝死(SCD)是HCM灾难性的临床结局。儿童或青少年时期确诊的HCM患者症状更多,预后可能更差。根据《中国成人肥厚型心肌病诊断与治疗指南2023》,临床上将HCM分为梗阻性肥厚型心肌病(oHCM)和非梗阻性肥厚型心肌病(nHCM)。静息时或激发后左心室流出道压差(LVOTG)峰值≥30 mmHg定义为oHCM;静息时和激发后LVOTG峰值均<30 mmHg则定义为nHCM。传统的非特异性药物β受体阻滞剂、钙通道阻滞药、丙吡胺疗效有限,玛伐凯泰是第一个心肌肌球蛋白抑制剂,是基于病因与发病机制进行精准治疗的心血管疾病药物。本文报道1例诊断为oHCM的患者,服用玛伐凯泰治疗后,临床症状明显改善。

     

    Abstract: Hypertrophic cardiomyopathy (HCM) is a major type of cardiovascular disease worldwide, posing a serious threat to human health. The clinical symptoms of HCM patients are highly variable: some patients may remain asymptomatic for a long time, while sudden cardiac death (SCD) is the first symptom in others. SCD represents a catastrophic clinical outcome of HCM. Patients diagnosed with HCM in childhood or adolescence tend to have more symptoms and may have a poorer prognosis. According to the 2023 Chinese Guidelines for the Diagnosis and Treatment of Adult Hypertrophic Cardiomyopathy, HCM is clinically classified into two subtypes: obstructive hypertrophic cardiomyopathy (oHCM) and nonobstructive hypertrophic cardiomyopathy (nHCM). Obstructive HCM is defined as a peak left ventricular outflow tract pressure gradient (LVOTG) of ≥ 30 mmHg at rest or after provocation; nonobstructive HCM is defined as a peak LVOTG of < 30 mmHg both at rest and after provocation. Traditional non-specific drugs, such as beta-blockers, calcium channel blockers, and disopyramide, have limited efficacy. Mavacamten, the targeted therapeutic agent classified as first myocardial myosin inhibitor, cardiovascular drug for precision treatment based on the etiology and pathogenesis of the disease. This article reports a case of a patient diagnosed with oHCM, whose clinical symptoms improved significantly after treatment with mavacamten.

     

/

返回文章
返回