心尖肥厚型与间隔肥厚型心肌病的心电图特点分析

目的 探讨心尖肥厚型及间隔肥厚型心肌病的心电图特点及临床指导意义。 方法 选择2017年1月—2019年1月在中国科学技术大学附属第一医院就诊符合肥厚型心肌病诊断标准的患者55例,根据肥厚部位不同分为心尖肥厚型组(17例,30.91%)和间隔肥厚型组(38例,69.09%)。对比分析2组临床资料、心脏彩超参数及心电图Ⅲ导联的R/S、Q波、S波、V4-6、-AVR导联T波等参数。 结果 间隔肥厚型[(15.71±4.88) mm]与心尖肥厚型心肌病[(11.18±2.70) mm]相比室间隔厚度差异有统计学意义(t=8.701,P<0.05)。心尖肥厚型心肌病V4-6(15例,88.24%)、-AVR导联倒置T波(16例,94.12%)所占比例与间隔肥厚型心肌病相比差异有统计学意义(χ2=7.275、10.162,均P<0.05)。间隔肥厚型心肌病Ⅲ导联R/S<1、主波向下所占的比例(21例,55.26%)与心尖肥厚型心肌病(4例,23.53%)相比差异有统计学意义(χ2=4.771,P<0.05),其余心电参数2组间差异无统计学意义(均P>0.05)。 结论 心尖肥厚型与间隔肥厚型心肌病心电图表现不同,V4-6、-AVR导联T波,Ⅲ导联主波方向,结合心脏彩超、临床资料对不同类型肥厚型心肌病的早期诊断及肥厚部位的定位具有很好提示作用。 

Analysis of electrocardiogram characteristics of apical hypertrophic cardiomyopathy and septal hypertrophic cardiomyopathy

Objective To explore the electrocardiographic characteristics and clinical significance of apical hypertrophic cardiomyopathy and septal hypertrophic cardiomyopathy. Methods A total of 55 patients who met the diagnostic criteria of hypertrophic cardiomyopathy were selected from January 2017 to January 2019 in our hospital. According to different fat parts, patients were divided into apical hypertrophic group(17 cases, 30.91%) and septal hypertrophic group(38 cases, 69.09%). The clinical data, echocardiographic parameters and the parameters of Ⅲ lead, R/s, Q wave, S wave, V4-6,-aVR lead T wave were compared and analyzed. Results There was a significant difference in the interventricular septal thickness between the septal hypertrophic group [(15.71±4.88) mm] and apical hypertrophic group [(11.18±2.70) mm, t=8.701, P<0.05]. The proportion of V4-6(15 cases, 88.24%) and-aVR lead inverted T wave(16 cases, 94.12%) in apical hypertrophic group was statistically significant compared with septal hypertrophic group(χ2=7.275, 10.162, P<0.05). There was a significant difference in the proportion of R/s<1 in lead Ⅲ and main wave downward in septal hypertrophic group(21 cases, 55.26%) compared with that in apical hypertrophic group(4 cases, 23.53%, χ2=4.771, P<0.05). There was no significant difference in the other electrocardiographic parameters between the two groups(all P>0.05). Conclusion The electrocardiographic of apical hypertrophic cardiomyopathy is different from that of septal hypertrophic cardiomyopathy. It can provide a good indication for the early diagnosis of different types of hypertrophic cardiomyopathy and the location of hypertrophic sites through the T wave of lead V4-6,-AVR, the main wave direction of lead Ⅲ, combined with echocardiography and clinical data.