心尖肥厚型心肌病18例临床分析

目的:对心尖肥厚型心肌病辅助检查进行分析,探讨其临床诊断价值。方法:以心电图、超声心动图、磁共振、冠状动脉造影及左室造影等检查方法检测18例心尖肥厚型心肌病。结果:18例心电图显示胸前导联T波倒置呈TV4>TV5>TV3,R波振幅增高以RV4>RV3> RV5;超声心动图左室心尖室壁舒张期厚度(17.22±14.20mm)与心室间隔基底段厚度(1.07±0.23mm)之比为1.60±0.16;4例冠状动脉造影检查后排除冠心病;6例因超声心动图不典型而行磁共振心脏成像检查后确诊。结论:标准12导联心电图显示胸前导联T波倒置伴R波增高应高度怀疑心尖肥厚型心肌病,可进一步行超声心动图或磁共振检查确诊。     

心尖肥厚型心肌病4例心电图分析

<正>心尖肥厚型心肌病的心电图特点为中部胸前导联巨大倒置T波,常以V_3、V_4为中心。若患者为青壮年,无明显胸痛胸闷症状,也无明显冠心病易患因素,此时就应疑及此病。本文4例均为ECG改变疑有心尖肥厚型心肌病,再作心脏超声而明确诊断,报告如下:例1:男性,47岁,有高血压史2年,ECG:Ⅰ、Ⅲ及V_3～V_4为中心的ST段下垂型压低,伴T波增宽倒置(见图1),临床医生疑为心尖肥厚型心肌病,但心脏超声医生未报告心尖部心肌厚度,当日再去另院心脏超声复查,报告室隔厚度19mm,心尖部心肌厚度23mm。     

心尖肥厚型心肌病患者心电图的诊断意义

目的探讨心尖肥厚型心肌病患者的心电图特征性改变及临床诊断意义。方法分析38例心尖肥厚型心肌病患者的心电图及超声心动图资料。结果心尖肥厚型心肌病合并有心电图异常和超声心动图异常改变者38例(100%),其中伴胸前导联巨大倒置T波≥0.2mV～0.3mV,以V3～V4最明显29例(76%);左胸V4～V6导联R波电压增高,且RV4>RV5>RV6者26例(68.4%);ST段压低,以V3～V4最明显者29例(76%);超声心动图示心尖部肥厚达15mm或以上伴心尖部心腔狭小者38例。结论心电图对心尖肥厚型心肌病具有早期诊断价值和预测意义。     

心尖部肥厚型心肌病的影像学诊断特点

目的 探讨心尖部肥厚型心肌病影像学检查特点,总结更为合理的诊断和治疗方法.方法 回顾性分析我院2004年1月至2010年1月期间60例诊断为心尖部肥厚型心肌病患者的临床表现,心电图、超声心动图、冠状动脉造影、左室造影、256层螺旋CT及心脏磁共振检查的特点,以及治疗后随访1年的心血管事件.结果 60例患者中56例表现为V1～V6导联 ST段压低,T波倒置,尤以V4 T波深倒;1例为完全性右束支传导阻滞;2例表现为AVR抬高,V3～V6导联ST段压低,T波倒置;1例Ⅲ、V1 T波倒置,V2～V6 T波双向.超声心动图异常改变48例（80%）,其中38例表现为不同程度的心尖部肥厚,厚度均≥15 mm,最厚可达22～24 mm.冠脉造影41例,仅有1例为前降支中段狭窄约70%,2例为前降支近中段肌桥形成,其余38例冠脉血管均正常.左室造影32例表现为左室腔舒张末期呈＂黑桃＂形改变,9例表现为＂猫舌＂状.10例患者行256层心脏及冠脉CTA检查,2例发现前降支近中段肌桥,8例冠脉正常;10例患者表现为心尖部增厚,厚度为15～21 mm.9例患者行心脏磁共振（CMR）检查,7例发现心尖部肥厚,厚度14～28 mm.结论 心尖部肥厚型心肌病容易误诊为冠心病.结合心电图和超声心动图可进一步明确,左心室造影、多层螺旋CT及心脏MRI为该病的诊断提供了确诊的依据.     

非冠心病所致深而倒置的T波（综述）

心电图深而倒置的T波,多见于冠心病无Q波心肌梗塞(心内膜下心肌梗塞)、不稳定心绞痛时心肌缺血,也可由非冠心病引起.本文对非冠心病引起深而倒置T波的心电图特点、发生机理及与冠心病T波倒置的鉴别作一简述.一、心尖肥厚性心肌病心失肥厚型心肌病是由日本学者首先报道,以向心性心尖肌肥厚为特征的特殊类型的肥厚型心肌病.其心电图特征为胸前导联巨大倒置的T波(T_V_3-V_6倒置>10mm)伴ST段压低、左室电压升高.有研究观察了肥厚型心肌     

心尖肥厚型心肌病的临床诊断探讨

目的 了解心尖肥厚型心肌病的临床表现和辅助检查特点。方法 总结２９例心尖肥厚型心肌病的临床表现和心电图,超声心动图,核素心肌断层显像,运动平板心电图及冠状动脉和左室造影的特征,确定心尖肥厚型心肌病的诊断方法。结果 心电图显示以胸导为主的导联Ｒ波振幅呈Ｖ４≥Ｖ５〉Ｖ３关系增高,同时伴有Ｔ波对称性深倒置,超声心动图和核素心肌断层显像显示心尖部肌肉肥厚,２０例活动平板心电图有心肌缺血,左心室造影心尖部肌     

心尖肥厚型心肌病的临床诊断(附13例临床报告)

目的：探讨心尖肥厚型心肌病的心电及影像学检查的特点及临床诊断价值。方法：对13例心尖肥厚型心肌病的心电图、超声心动图、放射核素心肌断层显像、冠状动脉造影及左室造影、磁共振成像等检查方法进行分析总结。结果：心电图的典型改变是胸前导联巨大倒置的T波伴ST段下降和QRS波群高血压,以V4导联最为显。超声心动图示心尖部肥厚,心尖部心室腔狭小甚至闭塞。磁共振成像清晰显示心尖部心肌肥厚。心室造影左心室舒张末期呈“黑桃”样改变,但部分呈“非黑桃”样改变。结论：心电图胸前导联巨大倒置T波TV4＞TV5伴QRS波群高血压RV4＞RV5是诊断AHCM的重要线索。超声心动图是诊断AHCM的重要手段。磁共振成像对确诊该病最有价值。心血管造影及放射性核素心肌显像是AHCM的鉴别诊断手段但不是必备检查。     

心尖肥厚型心肌病的超声诊断及随访

目的　探讨心尖肥厚型心肌病的超声诊断、临床症状及预后。方法　对超声心动图诊断的 12例心尖肥厚型心肌病患者 (男 8例 ,女 4例 )进行 1～ 15年的随访。结果　 12例患者的心尖部心肌明显增厚 16～ 38mm ,平均 2 0 6mm ,随访期间仅偶有胸痛、胸闷及心悸 ,尚未出现恶性心律失常及心肌梗死。结论　心尖肥厚型心肌病的诊断主要依靠超声心动图 ,心前导联巨大倒置的T波有助于本病的诊断 ,本病病情进展缓慢 ,预后良好。     

心尖肥厚型心肌病45例临床分析

目的 探讨心尖肥厚型心肌病的临床特点.方法 将惠者分别进行心电图、超声心动图、心肌核磁共振成像、左心室造影检查,进行分析.结果 45例患者心电图有胸前导联高电压,ST段压低及T渡深倒置,超声有心尖部心肌肥厚,左心室造影有心尖肥厚、心腔变小的表现,MRI呈"铁铲"样改变、心腔变小.结论 心电图、超声心动图、心肌核磁共振成像、左心室造影都是诊断心尖肥厚型心肌病的有价值的方法.其中左心室造影是比较可靠的方法.     

肥厚型心肌病出现巨大倒置T波的临床意义

日本学者曾描述一种伴有巨大倒置 T 波的、局限于心尖部的肥厚型心肌病。本研究以西方病人为对象,比较伴有和没有巨大倒置T 波的肥厚型心肌病的临床、二维超声心动图、放射性同位素心室显像以及48小时动态心电图的特征。方法 A 组27例病人伴有而 B 组56例病人没有巨大倒置 T 波(波幅≥10mm)。临床特征包括诊断时年龄、家族史、胸疼,呼吸困难和昏厥等。在心电图上观察左室肥厚程度、有无右室肥厚以及异常 Q 波。二维超声心动图评价左室壁厚度、心室大小、室间隔不对称     

心尖肥厚型心肌病与典型肥厚型心肌病的临床特点比较

目的 通过与典型的肥厚型心肌病(HCM)比较,探讨中国汉族人心尖肥厚型心肌病(AHCM)的临床特征及其诊治方法.方法 回顾性收集160例HCM住院患者的临床资料,分成3组进行比较.AHCM组:AHCM 41例.典型HCM患者(室间隔以及左心室壁肥厚),根据是否存在流出道梗阻分成2组,即非梗阻性肥厚型心肌病(NOHCM)组,52例,左心室流出道压差＜30 mm Hg(1 mm Hg=0.133 kPa);梗阻性肥厚型心肌病(OHCM)组,67例,左心室流出道压差≥30mm Hg.比较3组患者的临床症状、诊治方法以及血浆生物标记物水平.结果 (1)AHCM组患者的发病年龄较OHCM组晚[(49.9±13.6)岁比(41.4±14.6)岁,P＜0.01],无猝死家族史,较少出现劳力性呼吸困难,血浆血N末端B型利钠肽原(NT-pro BNP)水平较OHCM组低(P＜0.01).血浆心肌酶中肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、肌钙蛋白I(TnI)和肌红蛋白(MYO)的水平在3组间差异均无统计学意义.(2)31例AHCM患者因冠心病收治入院,经检查后,18例(18/41,43.9%)排除了冠心病.(3)AHCM组、NOHCM组和OHCM组心电图上深尖倒置T波(GNT)出现的频率分别为43.9%、13.5%和4.4%(P＜0.01),且AHCM组多伴有左心室高电压.(4)心脏核磁共振诊断AHCM明显优于心脏超声,与诊断典型HCM相比更有优势.结论 AHCM与典型OHCM的临床特点比较差异有统计学意义,而与典型的NOHCM比较差异无统计学意义.心脏核磁共振检查阳性及心电图胸导联上典型的GNT可为确诊AHCM提供依据.

Abstract：

Objective To evaluate the clinical features in Chinese patients with apical hypertrophic cardiomyopathy (AHCM) and typical hypertrophic cardiomyopathy (HCM). Methods This retrospective analysis included 160 patients hospitalized in Fuwai hospital. Patients were divided into three groups: apical hypertrophic cardiomyopathy ( AHCM, n = 41 ) group, non-obstructive typical hypertrophic cardiomyopathy group[NOHCM, LVOT ＜30 mm Hg(1 mm Hg =0. 133 kPa) at rest, n =52] and obstructive typical hypertrophic cardiomyopathy (OHCM, LVOT ≥ 30 mm Hg at rest, n = 67). Clinical features, diagnosis,therapy, and plasma levels of biomarkers of these three groups were analyzed. Results ( 1 ) The age at disease onset was older in AHCM group than in OHCM group [(49. 9 + 13. 6) years vs. (41.4± 14. 6)years, P ＜ 0. 01]. Exertional dyspnea appered more often in HCM patients than in AHCM patients, NT-proBNP level was significantly lower in AHCM patients than in OHCM patients (P =0. 001 ). Plasma CK-MB, LDH, TnI and MYO levels were similar among the three groups. (2) Thirty-three AHCM patients were first hospitalized for suspected coronary heart disease (CHD) and CHD was excluded in 18 cases (43.9%).(3) The frequency of giant negative T waves (depth≥10 mm) on ECG was 43.9%, 13.5% and 4.4%(P ＜ 0. 01 ) in AHCM, NOHCM and OHCM respectively. Half of AHCM patients showed left ventricular high voltage on ECG. (4) Cardiac magnetic resonance imaging is superior to echocardiography on correctly diagnosing AHCM. Conclusion AHCM patients differ from typical OHCM patients in clinical characteristics. There were significant differences on echocardiography and electrocardiography features among three groups. Cardiac magnetic resonance imaging and giant negative T waves on ECG are helpful for the diagnosis of AHCM.     

肥厚型心肌病的超声心动图及心电图分析

目的观察肥厚型心肌病的心电图和超声心动图特点。方法对临床确诊的32例肥厚型心肌病患者心电图、超声心动图资料进行回顾性分析。结果所有患者心电图均有异常,以ST-T改变、左室高电压和异常Q波为多见。Q波深度与室间隔厚度、ST压低深度与心尖部室壁厚度均呈正相关,而T波深度与心尖部室壁厚度无相关性,但与心尖部和室间隔的室壁厚度差呈正相关,左房大小与平均室壁厚度呈正相关。结论在肥厚型心肌病中,心电图和超声心动图中的许多异常指标具有相关性,两者结合可提高本病诊断率。     

Apical hypertrophic cardiomyopathy as a cause of cardiac insufficiency in an 84-year-old woman--a case report

Apical hypertrophic cardiomyopathy (ApHCM) is a unique form of hypertrophic cardiomyopathy first described in Japan in 1976. The typical features of ApHCM consist of 'giant' negative T waves in the ECG and a 'spade-like' configuration of the left ventricular cavity detected by imaging techniques. We describe a case of an 84-year-old female in whom heart failure was the first symptom of the disease.     

Can echocardiography and ECG discriminate hereditary transthyretin V30M amyloidosis from hypertrophic cardiomyopathy?

Objective: Hereditary transthyretin (ATTR) amyloidosis with increased left ventricular wall thickness could easily be misdiagnosed by echocardiography as hypertrophic cardiomyopathy (HCM). Our aim was to create a diagnostic tool based on echocardiography and ECG that could optimise identification of ATTR amyloidosis.

Methods: Data were analysed from 33 patients with biopsy proven ATTR amyloidosis and 30 patients with diagnosed HCM. Conventional features from ECG were acquired as well as two dimensional and Doppler echocardiography, speckle tracking derived strain and tissue characterisation analysis. Classification trees were used to select the most important variables for differentiation between ATTR amyloidosis and HCM.

Results: The best classification was obtained using both ECG and echocardiographic features, where a QRS voltage >30?mm was diagnostic for HCM, whereas in patients with QRS voltage <30?mm, an interventricular septal/posterior wall thickness ratio (IVSt/PWt) >1.6 was consistent with HCM and a ratio <1.6 supported the diagnosis of ATTR amyloidosis. This classification presented both high sensitivity (0.939) and specificity (0.833).

Conclusion: Our study proposes an easily interpretable classification method for the differentiation between HCM and increased left ventricular myocardial thickness due to ATTR amyloidosis. Our combined echocardiographic and ECG model could increase the ability to identify ATTR cardiac amyloidosis in clinical practice.     

Apical hypertrophic cardiomyopathy: variability of bidimensional echocardiographic and electrocardiographic expression

Apical hypertrophic cardiomyopathy is characterized by primary hypertrophy of the myocardium which is localized exclusively at the apex of the left ventricle. Previous studies have indicated that apical hypertrophic cardiomyopathy is characterized by a unique combination of cross-sectional echocardiographic and ECG findings ("giant" T wave inversion and high R wave voltage in the precordial leads). The aim of this study was to evaluate the possible relation between apical hypertrophy, quantitatively defined by cross-sectional echocardiography, and ECG findings in patients with apical hypertrophic cardiomyopathy. We studied 13 pts with apical hypertrophic cardiomyopathy, 10 men and 3 women (aged between 11 and 73 years, mean age 47). Apical hypertrophy was assessed quantitatively by determinating the muscle cross-sectional area in the apical region. From the end-diastolic apical 4 chamber view, endocardial and epicardial contours were digitized in order to obtain the muscle cross-sectional area of the left ventricle. The walls of the left ventricle were then divided into 3 regions (basal, mid-ventricular, apical). Final values of planimetered muscle areas are given as the average of the calculations obtained blindly and independently by 4 observers. The comparison between cross-sectional echocardiographic and electrocardiographic findings showed that patients with giant T wave inversion (T wave greater than 10 mm) and high R wave voltages (R greater than wave 25 mm) had a more severe degree of apical hypertrophy. However there was no complete agreement between cross-sectional echocardiographic and electrocardiographic findings. This study in fact demonstrates a wide variation in the degree of severity of apical hypertrophy among patients with apical hypertrophic cardiomyopathy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Usefulness of left ventricular opacification with intravenous contrast echocardiography in patients with asymptomatic negative T waves on electrocardiography

OBJECTIVES: Patients with electrocardiography (ECG) abnormalities sometimes present without obvious symptoms or abnormal physical findings. In some cases, echocardiography fails to reveal abnormalities compatible with the ECG findings because of poor echocardiographic image quality. New intravenous contrast agents now enable opacification of the left ventricular cavity in the clinical setting. The usefulness of left ventricular opacification (LVO) by ultrasonic contrast agent was examined in asymptomatic patients with negative T waves on ECG. METHODS: Thirty-four consecutive patients (23 males, 11 females, mean age 68 +/- 10 years) with negative T waves without symptoms or abnormal physical findings underwent routine transthoracic echocardiography and LVO by intravenous injection of Levovist using harmonic imaging. RESULTS: Without LVO, abnormal echocardiographic findings compatible with the negative T waves were identified in 22 (65%) of the 34 patients. With LVO, the endocardial border of the left ventricle was observed in all patients and findings compatible with negative T waves were detected in 32 (94%) of the 34 patients, which was significantly higher than that without LVO (chi 2 = 9.79, p = 0.0055). Furthermore, LVO revealed additional findings in nine patients such as mural thrombus or apical thinning. In total, LVO revealed abnormal apical findings in 22 patients (65%), which was significantly higher than that without LVO (chi 2 = 10.0, p = 0.0013). CONCLUSIONS: LVO is useful for identifying abnormal findings, especially in the apex in asymptomatic patients with negative T waves on ECG.     

Comparison of usefulness of Sokolow and Cornell criteria for left ventricular hypertrophy in subjects aged <20 years versus >30 years

The use of electrocardiography in sports or military screening is considered an effective tool for diagnosing potentially fatal conditions. The present study was designed to compare the yield of electrocardiographic criteria for left ventricular hypertrophy (LVH) criteria for the diagnosis of LVH and hypertrophic obstructive cardiomyopathy in subjects aged <20 years and >30 years. The association between the electrocardiographic (ECG) criteria for LVH (ECG-LVH) and echocardiographic findings was compared in 4 groups of air force academy candidates: (1) young candidates undergoing echocardiography because of ECG-LVH findings (n = 666); (2) young candidates without ECG-LVH findings undergoing routine echocardiography (n = 4,043); (3) older designated aviators undergoing echocardiography because of ECG-LVH findings (n = 196); and (4) older designated aviators undergoing routine echocardiography without ECG-LVH findings (n = 1,098). The predictive value of ECG-LVH findings for echocardiographic LVH, left ventricular mass, posterior wall thickness, and interventricular septal thickness were compared among the 4 groups. The ECG criteria in young subjects correlated with the left ventricular mass and posterior wall thickness but not with the interventricular septal thickness. In older subjects, these criteria correlated with left ventricular mass, interventricular septal, and posterior wall thickness. The positive and negative predictive value of ECG-LVH findings for the echocardiographic diagnosis of LVH in young subjects was 6.0% and 99.0%, respectively. In older subjects the positive and negative predictive value of ECG-LVH findings was 34% and 93%, respectively. In conclusion, ECG criteria are probably a useful tool for exclusion of LVH in young and older subjects; however, their low positive predictive value would probably lead to unnecessary echocardiographic tests, particularly in young subjects.     

心脏淀粉样变的心脏超声及心电图特点

目的：分析心脏淀粉样变患者的心脏超声及心电图特点,为临床医师早期识别和诊断心脏淀粉样变性提供帮助。方法：2003年7月～2011年10月我院结合临床及病理检查确诊心脏淀粉样变性患者20例,回顾性分析其超声心动图和心电图特点。结果：心脏超声检查所见：20例患者均表现室间隔[（15．67±3．60）mm]及左心室后壁向心性增厚[（15．73±3．54）mm]而左心室容积正常;所有患者均存在舒张功能不全;多数患者有左心房增大（19例,95％）,心内膜下心肌有颗粒样反光增强（17例,85％）,出现中一大量心包积液（11例,55％）。心电图表现为：20例患者心电图肢体导联的电压均较低,肢体导联低电压和假性梗死Q波的发生率分别为55％和45％。结论：不明原因心力衰竭的患者,如果心脏超声示心室肌肥厚且心室容积正常,伴心内膜下心肌内有颗粒样反光增强,而心电图又表现为肢体导联低电压或非梗死性Q波时,应考虑心脏淀粉样变性的可能性。应进一步行病理活检等检查,以利于早期诊断和治疗。     

Myocardial Stunning Following Combined Modality Combretastatin‐Based Chemotherapy: Two Case Reports and Review of the Literature

Myocardial stunning, known as stress cardiomyopathy, broken‐heart syndrome, transient left ventricular apical ballooning, and Takotsubo cardiomyopathy, has been reported after many extracardiac stressors, but not following chemotherapy. We report 2 cases with characteristic electrocardiographic and echocardiographic features following combined modality therapy with combretastatin, a vascular‐disrupting agent being studied for treatment of anaplastic thyroid cancer. In 1 patient, an ECG performed per protocol 18 hours after drug initiation showed deep, symmetric T‐wave inversions in limb leads I and aVL and precordial leads V₂ through V₆. Echocardiography showed mildly reduced overall left ventricular systolic function with akinesis of the entire apex. The patient had mild elevations of troponin I. Coronary angiography revealed no epicardial coronary artery disease. The electrocardiographic and echocardiographic abnormalities resolved after several weeks. The patient remains stable from a cardiovascular standpoint and has not had a recurrence during follow‐up. An electrocardiogram performed per protocol in a second patient showed deep, symmetric T‐wave inversions throughout the precordial leads and a prolonged QT interval. Echocardiography showed mildly reduced left ventricular function with hypokinesis of the apical‐septal wall. Acute coronary syndrome was ruled out, and both the electrocardiographic and echocardiographic changes resolved at follow‐up. Although the patient remained pain‐free without recurrence of anginal symptoms during long‐term follow‐up, the patient developed progressive malignancy and died. Copyright © 2009 Wiley Periodicals, Inc.