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Hjartavöðvasjúkdómur meðal kvenna : algengi metið með hjartaómun og krufningu

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Authors
Uggi Agnarsson
Þórður Harðarson
Jónas Hallgrímsson
Ásmundur Brekkan
Nikulás Sigfússon
Issue Date
1993-09-01

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Citation
Læknablaðið 1993, 79(7):271-8
Abstract
The purpose of this study was to estimate the prevalence of hypertrophic cardiomyopathy (HCM) in a group of 3922 women randomly selected from the Reykjavik study, phase IV, in 1981-1983. Of these, 358 women (9%) had an abnormal (group A) and 3564 (91%) had a normal electrocardiogram (ECG). In 1989, an echocardiography (echo) study of all surviving women from group A as well as a matched echo control group of 89 women (group B) from cohorts with a normal ECG, was performed, to identify subjects with HCM as well as a review of autopsy data and death certificates from deceased cohorts. To December 1st 1989 there had been a total of 100 deaths, 18 from group A and 82 from cohorts with a normal ECG, but no deaths had occurred amongst 89 selected for group B. HCM was identified by echo in 4 of 274 women examined but 66 did not attend. No case of HCM was found from the 76 attendees in group B. Autopsy diagnosed five additional cases of HCM from the 100 deceased cohorts. Thus a total of 9 cases of HCM were found. Three of four women diagnosed by echo were symptomatic but only one of five diagnosed at autopsy had apparent symptoms prior to death. Two of the five died suddenly. A echo-Doppler study was performed on the 4 HCM cases and the results compared to 40 normal controls in group B. The results showed an increased ejection velocity (P<0.001) and an increased late diastolic contribution to left ventricular filling in subjects with HCM (P<0.001). The prevalence of HCM and 95% confidence interval was calculated. We found 1.5% (0.4-3.8%) prevalence of HCM in women with an abnormal ECG and a calculated prevalence of 0.14% (0.04-3.9%) in the total group of 3922 as diagnosed by echo. The overall calculated minimal prevalence of HCM in women 30 to 73 years was 0.2% (0.1-0.6%).
Tilgangur þessarar rannsóknar var að meta algengi hjartavöðvasjúkdóms (HVS) í hópi 3922 fullorðinna kvenna, þátttakendum í hópþýði Rannsóknarstöðvar Hjartaverndar frá árunum 1981-1983. Við rannsóknina reyndust 358 konur (9%) (hópur A) hafa afbrigðilegt hjartarit og 3564 (91%) reyndust hafa eðlilegt hjartarit. Leit að hjartavöðvasjúkdómi var gerð með hjartaómun hjá öllum konum með afbrigðilegt hjartarit (hópur A) og hjá 89 konum með eðlilegt hjartarit (hópur B). Konur í hópi B voru á sambærilegum aldri og konur í hópi A. Einnig var farið yfir dánarvottorð og krufningaskýrslur þeirra 100 kvenna sem látist höfðu frá fyrstu skoðun til ársins 1989, 18 úr hópi kvenna með afbrigðilegt hjartarit og 82 með eðlilegt. HVS greindist meðal fjögurra af 274 konum sem mættu til hjartaómskoðunar úr hópi A en 66 mættu ekki. Af 76 konum úr hópi B reyndist engin hafa sjúkdóminn, en 13 mættu ekki. Við krufningu greindust fimm konur með HVS. Samtals fundust því níu konur með HVS, ein með afbrigðilegt og fjórar með eðlilegt hjartarit. Þrjár af fjórum sem greindust við hjartaómun reyndust hafa hjartaeinkenni en einungis ein af fimm sem greindust við krufningu virtist hafa haft hjartaeinkenni. Tvær þeirra létust skyndidauða. Blóðflæðirannsókn með Doppler aðferð á mítur- og útstreymisblóðrennsli var gerð hjá konum með HVS og niðurstöður bornar saman við blóðrennsli hjá konum með heilbrigt hjarta. Í ljós kom aukið vægi blóðrennslis seint í lagbili við fyllingu á vinstri slegli og aukinn rennslishraði á blóði út úr vinstri slegli og meðal kvenna með HVS. Algengi HVS og 90% vikmörk voru reiknuð. Algengi HVS reyndist 1,5% (0,4-3,8%) meðal kvenna með afbrigðilegt hjartarit og reiknað algengi meðal kvenna með eðlilegt hjartarit var 0,14% (0,04-3,9%). Lágmarksalgengi miðað við þær konur sem greindust með HVS í rannsókn okkar var 0,2% (0,1-0,6%) fyrir aldursbilið 30-73 ár.
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