超声心动图对缺血性心肌病和扩张型心肌病的鉴别诊断

目的探讨超声心动图对缺血性心肌病（ICM）和扩张型心肌病（DCM）的鉴别诊断价值。方法对临床确诊的33例缺血性心肌病和29例扩张型心肌病进行超声心动图检查，比较两者在心脏形态学、血流动力学及心功能方面的差异。结果①ICM组心脏左房室腔扩大呈“圆拱门形”，心尖圆钝变薄，室壁活动呈节段性障碍；DCM组心脏多个房室腔扩大呈“球形”，室壁变薄而心尖部不变薄，室壁活动呈弥漫性减弱；②IcM组多为单瓣膜返流且程度较轻；DCM组多瓣膜返流发生率高且程度较重；ICM组主动脉瓣返流高于DCM组（P〈0．05）；③DCM组以收缩功能降低为主，舒张功能可表现为正常；ICM组以舒张功能障碍为主，收缩功能可表现为正常；二尖瓣E／A：ICM组〈1或〉2，而DCM组〉1（P〈0．05）。结论超声心动图是缺血性心肌病与扩张型心肌病鉴别的一种有价值的无创性手段。

The different diagnosis of echocardiography for ischemic cardiomyopathy and dilated cardiomyopathy

Objective To investigate the different diagnostic value of echocardiography for ischemic cardiomyopathy（ICM） and dilated cardiomyopathy （DCM）. Methods 33 patients with ICM and 29 patients with DCM received echocardiography, The findings in cardiac morphology, hemodynamics and heart function between ICM and DCM was compared. Results （1）In ICM group left atrioventricular cavity was dilated, the apex of left ventricle was thin spherical , the ventricular wall motion decreased segmentally; in DCM group several at- rioventricular cavities were global enlarged, normal contractible apex was founded, the ventricular wall motion decreased diffusely. （2）Slight regurgitation of single valve was common in ICM ,but severe regurgitation of multiple valves was more common in DCM; aortic regurgitation in ICM group was larger than that in DCM group （P 〈0.05）. （3）In DCM group cardiac systolic function was mostly decreased, whereas diastolic function may be normal; in ICM group diastolic function was markedly decreased, but systolic function may be normal; E/A of the mitral valve was 〈 1 or 〉 2 in ICM group, but was 〉 1 in DCM group （P 〈 0.05 ）. Conclusion Echocardiography is a valuable noninvasive technology for differentiating ICM and DCM.