心尖肥厚型心肌病的MRI与超声心动图对比研究

目的分析心尖肥厚型心肌病(AHCM)的MRI与超声心动图影像征象,比较MRI与超声心动图对心尖肥厚型心肌病的诊断价值。材料与方法对21例心尖型肥厚型心肌病患者(男16例,女5例)行心脏MRI、超声心动图、心电图等检查。结果 21例患者心脏MRI均提示心尖部心肌肥厚,单纯型P-AHCM13例,单纯型T-AHCM 1例,混合型P-AHCM 1例,混合型T-AHCM 6例。7例T-AHCM均表现为典型的"黑桃心"征象(ace of spades)(33.3%)。4例患者行心肌对比增强MR扫描,3例示心尖部心肌纤维化,2例患者存在心肌缺血,2例患者存在心肌梗死。而心脏超声仅6例明确提示心尖部心肌肥厚,10例患者超声检查未见明显异常。21例患者心电图均存在ST-T改变:其中14例左胸导联RV4-6电压增高(67.7%);17例左胸导联产生的前后肢对称、深倒置的巨大T波(80.9%);16例ST段水平压低(76.2%);4例患者存在不同程度的心律失常(19.0%)。结论MR诊断AHCM具有很高的准确性;超声心动图诊断心尖型肥厚型心肌病敏感性低;心电图是心尖肥厚型心肌病有效的筛查方法;对于临床怀疑心尖型肥厚型心肌病的患者可采用心脏MRI明确诊断。

Comparing cardiac magnetic resonance with echocardiogram on diagnosis of apical hypertrophic cardiomyopathy

AbrtractObjective:To discuss the character of cardiac magnetic resonance and echocardiogram findings of apical hypertrophic cardiomyopathy (AHCM), and evaluate the diagnostic value of CMR and echocardiogram in AHCM.Materials and Methods: Twenty-one patients (male 16, female 5) with AHCM underwent Cardiac Magnetic Resonance, echocardiogram, ECG and coronary angiography. Results:The cardiac magnetic resonance revealed apical hypertrophic in all the patients. Among them, 13 patients were pure form P-AHCM, 1 patient was pure form T-AHCM, 1 patient was mixed form P-AHCM, and 6 patients were mixed form T-AHCM. Magnetic resonance imaging showed “ace of spades” morphology of the left ventricle in all the T-AHCM patients. Four patients underwent myocardial contrast enhancement MR scanning: 3 patients presented LGE, 2 patients presented myocardial ischemia, and 2 patients presented myocardial infarction. Echocardiography provided correct diagnoses in 6/21 patients (28.6%), while in 10 patients echocardiographic results were normal. All of our patients showed electrocardiographic alterations of the ventricular repolarization: 14 patients (67.7%) with LV high voltage. Seventeen patients (80.9%) with giant negative T waves. Sixteen patients (76.2%) with a signiifcant descending ST segment. Four patients had arrhythmia in different degrees.Conclusions: MR has higher sensitivity in diagnosing AHCM than echocardiogram. The ECG is a helpful tool to screen AHCM. To the patients who is suspected of AHCM, cardiac magnetic resonance could make a deifnite diagnosis.