循環器ジャーナル70巻1号

2022年01月発行

特集 心筋症診療のフロントライン—概念から最新の治療まで Ⅴ章　心肥大と出会ったら

HCMの心不全症状へのアプローチ

著者： 髙見澤格¹

所属機関： ¹榊原記念病院循環器内科

ページ範囲：P.116 - P.125

Point
・β遮断薬による薬物治療を開始する．閉塞性の場合はカルシウム拮抗薬・Naチャンネル阻害薬を併用する．
・薬物治療によっても心不全症状が残存し，左室内圧較差が50 mmHgを超える場合は中隔心筋縮小術を積極的に検討する．
・左室内構造異常など，解剖学的な評価をマルチモダリティでしっかり行い治療方針をたてる．

参考文献

1）Authors/Task Force members ; Elliott PM, Anastasakis A, Borger MA, et al : 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy : The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology（ESC）. Eur Heart J 35 : 2733-2779, 2014

2）日本循環器学会，日本心不全学会，日本心臓病学会，他：日本循環器学会/日本心不全学会合同ガイドライン　心筋症診療ガイドライン（2018年改訂版）．2019年3月29日発行，2021年6月22日更新．

3）Matsumori A, Furukawa Y, Hasegawa K, et al : Epidemiologic and Clinical Characteristics of Cardiomyopathies in Japan : Results From Nationwide Surveys. Circ J 66 : 323-336, 2002

4）Ommen SR, Mital S, Burke MA, et al : 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy : A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 142 : e558-e631, 2020

5）Sherrid MV, Chaudhry FA, Swistel DG : Swistel. Obstructive Hypertrophic Cardiomyopathy : Echocardiography, Pathophysiology, and the Continuing Evolution of Surgery for Obstruction. Ann Thorac Surg 75 : 620-632, 2003

6）Maron BJ, Maron MS : Hypertrophic cardiomyopathy. Lancet 381 : 242-255, 2013

7）Maron MS, Olivotto I, Betocchi S, et al : Effect of Left Ventricular Outflow Tract Obstruction on Clinical Outcome in Hypertrophic Cardiomyopathy. N Engl J Med 348 : 295-303, 2003

8）Hamada M, Ikeda S, Shigematsu Y : Advances in medical treatment of hypertrophic cardiomyopathy. J Cardiol 64 : 1-10, 2014

9）Hamada M, Ikeda S, Ohshima K, et al : Impact of chronic use of cibenzoline on left ventricular pressure gradient and left ventricular remodeling in patients with hypertrophic obstructive cardiomyopathy. J Cardiol 67 : 279-286, 2016

10）Olivotto I, Oreziak A, Barriales-Villa R, et al : Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy（EXPLORER-HCM） : a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 396 : 759-769, 2020

11）Maron BJ, Nishimura RA, McKenna WJ, et al : Assessment of Permanent Dual-Chamber Pacing as a Treatment for Drug-Refractory Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy. A Randomized, Double-Blind, Crossover Study（M-PATHY）. Circulation 99 : 2927-2933, 1999

12）Nishimura RA, Trusty JM, Hayes DL, et al : Dual-chamber pacing for hypertrophic cardiomyopathy : a randomized, double-blind, crossover trial. J Am Coll Cardiol 29 : 435-441, 1997

13）Kappenberger L, Linde C, Daubert C, et al : Pacing in hypertrophic obstructive cardiomyopathy : A randomized crossover study. Eur Heart J 18 : 1249-1256, 1997

14）日本循環器学会，日本心臓病学会，日本心臓血管外科学会，他：2021年改訂版　先天性心疾患，心臓大血管の構造的疾患（structural heart disease）に対するカテーテル治療のガイドライン．2021

15）GOODWIN JF, HOLLMAN A, CLELAND WP, et al : Obstructive cardiomyopathy simulating aortic stenosis. Br Heart J 22 : 403-414, 1960

16）MORROW AG, BROCKENBROUGH EC : Surgical treatment of idiopathic hypertrophic subaortic stenosis : technic and hemodynamic results of subaortic ventriculomyotomy. Ann Surg 154 : 181-189, 1961

17）Morrow AG, Reitz BA, Epstein SE, et al : Operative treatment in hypertrophic subaortic stenosis. Techniques, and the results of pre and postoperative assessments in 83 patients. Circulation 52 : 88-102, 1975

18）Morrow AG : Hypertrophic subaortic stenosis. Operative methods utilized to relieve left ventricular outflow obstruction. J Thorac Cardiovasc Surg 76 : 423-430, 1978

19）Brugada P, de Swart H, Smeets JL, et al : Transcoronary Chemical Ablation of Ventricular Tachycardia. Circulation 79 : 475-482, 1989

20）Sigwart U : Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy. Lancet 346 : 211-214, 1995

21）Fifer MA, Sigwart U : Controversies in cardiovascular medicine. Hypertrophic obstructive cardiomyopathy : alcohol septal ablation. Eur Heart J 32 : 1059-1064, 2011

22）Imori Y, Takano H, Kitamura M, et al : Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy through non-left anterior descending septal perforators. Heart Vessels 35 : 647-654, 2020

23）Faber L, Seggewiss H, Gleichmann U : Percutaneous transluminal septal myocardial ablation in hypertrophic cardiomyopathy : Results with respect to intraprocedual myocardial contrast echocardiography. Circulation 98 : 2415-2421, 1998

24）高山守正：閉塞性肥大型心筋症に対する経皮的中隔心筋焼灼術（PTSMA）．Ⅲ肥大型心筋症．吉田清，大倉宏之（編）：SHDインターベンション治療のための心エコー図マニュアル．メジカルビュー社，2014

25）Chang SM, Lakkis NM, Franklin J, et al : Predictors of Outcome After Alcohol Septal Ablation Therapy in Patients With Hypertrophic Obstructive Caridiomyopathy. Circulation 109 : 824-827, 2004

26）McCully RB, Nishimura RA, Tajik AJ, et al : Extent of clinical improvement after surgical treatment of hypertrophic obstructive cardiomyopathy. Circulation 94 : 467-471, 1996

27）ten Cate FJ, Soliman OI, Michels M, et al : Long-Term Outcome of Alcohol Septal Ablation in Patients With Obstructive Hypertrophic Cardiomyopathy : a word of caution. Circ Heart Fail 3 : 362-369, 2010

28）McGregor JB, Rahman A, Rosanio S, et al : Monomorphic Ventricular Tachycardia : A Late Complication of Percutaneous Alcohol Septal Ablation for Hypertrophic Cardiomyopathy. Am J Med Sci 328 : 185-188, 2004

29）Jensen MK, Almaas VM, Jacobsson L, et al : Long-Term Outcome of Percutaneous Transluminal Septal Myocardial Ablation in Hypertrophic Obstructive Cardiomyopathy : A Scandinavian Multicenter Study. Circ Cardiovasc Interv 4 : 256-265, 2011

30）Liebregts M, Vriesendorp PA, Mahmoodi BK, et al : A Systematic Review and Meta-Analysis of Long-Term Outcomes After Septal Reduction Therapy in Patients With Hypertrophic Cardiomyopathy. JACC Heart Fail 3 : 896-905, 2015

31）Leonardi RA, Kransdorf EP, Simel DL, et al : Meta-analyses of septal reduction therapies for obstructive hypertrophic cardiomyopathy : comparative rates of overall mortality and sudden cardiac death after treatment. Circ Cardiovasc Interv 3 : 97-104, 2010

32）Sedehi D, Finocchiaro G, Tibayan Y, et al : Long-term outcomes of septal reduction for obstructive hypertrophic cardiomyopathy. J Cardiol 66 : 57-62, 2015

33）Kimmelstiel C, Zisa DC, Kuttab JS, et al : Guideline-Based Referral for Septal Reduction Therapy in Obstructive Hypertrophic Cardiomyopathy Is Associated With Excellent Clinical Outcomes. Circ Cadiovasc Interv 12 : e007673, 2019