探讨肥厚型梗阻性心肌病特异性频谱对准确评估跨左室流出道压力阶差的价值

目的 通过研究肥厚型梗阻性心肌病(HOCM)左室流出道连续多普勒频谱形态来准确评估跨左室流出道压力阶差(LVOTG)的价值,进而利用超声心动图评估经皮室间隔化学消融治疗肥厚型梗阻性心肌病的效果。 方法 回顾性分析2012年1月—2017年3月因胸闷、呼吸困难等临床症状于安徽医科大学第二附属就诊,经胸、心脏超声检查考虑为肥厚型梗阻性心肌病的患者19例,根据左室流出道特异性“蟹足样”频谱的前、后峰流速,计算出LVOTG,将行经皮腔内室间隔化学消融术(PTSMA)治疗时术中心导管测压与超声心动图测LVOTG的值进行比较。分析12例未行PTSMA治疗的患者和7例行PTSMA治疗患者术前的“蟹足样”频谱第二峰流速和二尖瓣反流速度,同时将患者PTSMA术前、术后的“蟹足样”频谱第二峰流速和二尖瓣反流速度对比分析,评估PTSMA的效果。 结果 所有患者左室流出道均测得特异性“蟹足样”频谱、室间隔增厚(13~23 mm)、均伴有不同程度的二尖瓣反流(轻-中度),均伴有二尖瓣前向运动(SAM征)。采用配对样本t检验方法分析超声心动图测量的“蟹足样”频谱的第二峰流速测算的压力阶差与术中左心导管测压结果,差异无统计学意义(P<0.05),分析行PTSMA治疗后效果,行PTSMA治疗后患者的LVOTG降低,梗阻程度减轻,二尖瓣反流速度也相应的降低。 结论 超声心动图左室流出道流速处测量的“蟹足样”频谱的第二峰流速可用来测算压力阶差,为临床治疗HOCM选择合适的治疗方案。 

To investigate the value of the specific spectrum of hypertrophic obstructive cardiomyopathy in the accurate assessment of the pressure difference across the left ventricular outflow tract

Objective The value of left ventricular outflow tract pressure gradient (LVOTG) was accurately assessed by studying the Doppler spectrum of left ventricular outflow tract in hypertrophic obstructive cardiomyopathy (HOCM), and then use echocardiography to evaluate the effect of percutaneous septal chemical ablation on the treatment of hypertrophic obstructive cardiomyopathy. Methods Retrospective analysis of January, 2012 to March, 2017 due to chest tightness, dyspnea and other clinical symptoms to our hospital, transthoracic ultrasound examination for hypertrophic obstructive cardiomyopathy in 19 patients, LVOTG was calculated according to the anterior and posterior peak flow rates of the specific"crab-like"spectrum of the left ventricular outflow tract, and PTSMA treatment of intracardiac catheter pressure and echocardiography measured LVOTG values were compared. The frequency of second peak flow and mitral regurgitation were analyzed in 12 patients without PTSMA and 7 patients underwent PTSMA, and patients with PTSMA before and after the"crab like"second peak flow rate and the mitral regurgitation velocity were compared and analyzed to evaluate the effect of PTSMA. Results All patients with left ventricular outflow tract were measured specific"crab-like"spectrum and ventricular septal thickening (13-23 mm) are accompanied by varying degrees of mitral regurgitation (mild to moderate) and the forward movement of the valve (SAM sign). The results of the second peak flow velocity measured by echocardiography were analyzed by the paired sample t test. The difference between the pressure gradient and the left ventricular catheterization was not statistically significant. After PTSMA treatment of patients, the LVOTG and obstruction decreased, mitral regurgitation rate is also accordingly reduced. Conclusion The second peak velocity of the"crab like"spectrum measured by the velocity of the left ventricular outflow tract can be used to measure the pressure difference, and to select the appropriate treatment for the clinical treatment of HOCM.