心尖肥厚型心肌病超声诊断特点及随访

目的 探讨心尖肥厚型心肌病超声诊断特点及预后随访.方法 对27例心尖肥厚型心肌病患者心电图、超声心动图进行1～13年(平均5.2年)随访观察.结果 27例患者心电图胸前导联异常T波深置,V_(3-5)导联最为显著,重者出现巨大倒置T波≥10 mm,胸前导联R波振幅V_4>V_5>V_3,超声心动图显示心尖部明显增厚15～37(18.0±3.3)mm,末次随访心尖部厚度(19.7 ±3.7)mm,左室心尖部厚度与左室后壁厚度比值分别为1.7±0.3和1.9±0.9,随访前后比较差异有统计学意义(P<0.05),但左室舒张末期内径及左室射血分数随访前后未见显著差异.主要心血管事件为心房颤动,心功能Ⅲ～Ⅳ级,前壁心肌梗死及心脏猝死.结论 心尖肥厚型心肌病主要依据心电图胸前导联T波深置及超声心动图心尖肥厚特点作出诊断,该病进展缓慢,一般临床预后较好.

The echocardiographic diagnostic characteristics and follow-up of apical hypertrophic cardiomyopathy

Objective To evaluate the echocardiographic features of apical hypertrophic cardiomyopathy( ApHCM). Methods Twenty-seven patients with ApHCM including 21 men and 6 women, average age (42.7 ± 5. 1 ) years old were followed up from 1995 to 2008 to investigate the clinical, electroeardiographic and echocardiographic features. Results The major features of ECG were increased R amplitude( V_4 > V_5 > V_3)and inverteted T wave(especially in V_(3-5) leads and the voltage of the inverteted T waves may be up to ≥10 mm). The major feature of echocardiography was the thickening of left ventricular apical wall to 15 - 37 ( 18. 0± 3. 3 ) mm. The final follow up showed that the mean thickness of the apical wall was ( 19. 7 ±3. 7) mm. The ratio of the thickness of left ventricular apical wall to posterior wall before and after the follow up was 1. 7 ±0. 3 and 1. 9 ±0. 9 respectively, with significant statistical difference ( P < 0. 05). There was no difference in the left ventricular end-diastolic dimension and left ventricular ejection fraction. The main cardiovascular events were atrial fibrillation ( 16 cases) , heart failure of NYHA ID-IV class (3 cases) , anterior wall myocardial infarction ( 1 case) and sudden death ( 1 case). Conclusions The final diagnosis of ApHCM depends on the characteristic inverteted T wave in ECG and apical hypertrophy in echocardiography. The prognosis of ApHCM is rather good for its progression is relatively slow.