经胸超声心动图评价高血压心脏病与左心室流出道梗阻的应用价值

目的:应用经胸超声心动图(transthoracic echocardiography,TTE),评价高血压心脏病与肥厚型心肌病(HCM)左心室流出道梗阻的二维及血流动力学特征,为临床鉴别诊断提供影像学依据。方法:左心室流出道梗阻患者31例,其中高血压性左心室流出道梗阻12例,肥厚型梗阻性心肌病19例,二维图像下测量两组患者的室间隔厚度及左心室后壁厚度,在静息状态和激发试验后测量两组患者的左心室流出道流速及最大压差,分别进行组间及组内比较。结果:室间隔厚度肥厚型心肌病组(19.6±1.8)mm明显高于高血压组(12.4±0.6)mm,差异有统计学意义(P<0.05)。左心室后壁厚度:肥厚型心肌病组(11.5±0.5)mm,高血压组(11.3±0.6)mm,两组间比较差异无统计学意义(P>0.05)。高血压组组内比较激发试验后左心室流出道流速(398.6±36.7)cm/s及压差(68.4±12.9)mmHg,1 mmHg=0.133kPa],均高于静息状态下流速178.2±23.4)cm/s,压差(13.5±6.2)mmHg,差异有统计学意义(P<0.05)。结论:经胸超声心动图能准确评价左心室流出道梗阻的解剖结构与血流动力学特征,可准确鉴别梗阻类型及梗阻程度。

Application value of evaluation the left ventricular outflow obstruction of hypertention and hypertrophic cardiomyopathy by transthoracic echocardiography

Objective: To investigate the anatomic characteristics and feature of flow dynamics in left ventricular outflow obstruction of hypertention and hypertrophic cardiomyopathy(HCM) by TTE.Methods: 31 patients with left ventricular outflow obstruction including 12 patients with hypertension complicated with left ventricular outflow obstruction and 19 patients with HCM with obstruction of hypertrophic left ventricular out tract cardiomyopathy.The interventricular septal thickness(IVST),posterior wall thickness(PWT),left ventricular outflow velocity and maximum pressure grade of above two groups were measured at baseline and after provocation test.Results: IVST of Hypertrophic Cardiomyopathy group was obviously higher than hypertension group,the comparision between PWT of the two groups does not be significantly different.After provocation test,flow velocity of left ventricular outflow and pressure grade were higher than those at baseline.Conclusion: TTE can accurately evaluate left ventricular outflow obstruction,as well as the degree and type of the obstruction.