回顾性分析29例肥厚型心肌病超声心动图的特征

Retrospective study of echocardiographic characteristics in 29 cases with hypertrophic cardiomyopathy

目的探讨肥厚型心肌病(HCM)超声心动图的特征表现及其临床实际意义。方法对29例HCM患者超声心动图检查有关室壁厚度、心室收缩和舒张功能的参数进行回顾性分析。结果29例HCM患者室间隔舒张末期厚度(IVSTd)为(18.6±3.5)mm,左室后壁舒张末期厚度(LVPWTd)为(10.45±2.1)mm,IVSTd/LVPWTd比值为1.9±3.6,左心室舒张末期内径(LVIDd)为(44±4.9)mm。其中梗阻性HCM 10例,8例有二尖瓣收缩期前向运动(SAM);非梗阻性HCM 19例,有3例观察到SAM。梗阻性和非梗阻性HCM两组左室射血分数(LVEF%)正常,但组间比较无统计学意义(P>0.05)。左室后壁收缩期增厚率(LVPW△T%)均值较室间隔收缩期增厚率(IVS△T%)均值为大。梗阻性IVS△T%较非梗阻性更小(P<0.05)。梗阻性组IVSTdI、VSTd/LVPWTd比值、二尖瓣A波峰值与非梗阻性相比更大(P<0.05)。E/A比值在梗阻性<1,而在非梗阻性则>1,但组间无统计学意义(P>0.05)。结论超声心动图能很好识别HCM室壁异常增厚的特征,并能评价心室的收缩和舒张功能。深入认识HCM的超声心动图的特征对提高肥厚型心肌病及时诊断率具有临床实际意义。

Objective To analyze the characteristics of echocardiogram in patients with hypertrophic cardiomyopathy（HCM）. Methods Twenty-nine cases （years） were imaged by echocardiography to assess left ventricular （LV） wall thickness,the pressure gradient of left ventricular outflow tract （LVOTPG）,and the parameters evaluating systolic and diastolic function of LV. Results The thickness of LV posterior wall in diastolic phase（LVPWTd） was（10.45 ±2. 1 ）mm, and the thickness of interventricular septum in diastolic phase （IVSTd） was（18. 6±3.5）mm. IVSTd/LVPWTd ratio was 1. 9±3. 6. All cases were with normal systolic function,but 34 % （10 of the 29）patients with diastolic dysfunction, which evaluated by E/A ratio of mitral flow（0. 9 ±0. 5）. There was 10 cases with hypertrophic obstructive cardiomyopathy （HOCM） [LVOTPG= （78. 6±18. 5）mm Hg],and 19 cases with hypertrophic non-obstructive cardiomyopathy （HNOCM） O.VOTPG=（10.7±5.6）mm Hg,P〈0.01]. Conclusion Echocardiography is a reliable imaging diagnostic approach. Enhancing the characteristics of LV hypertrophy,echocardiography could be a powerful supplemental imaging diagnosis with distinct diagnostic advantages in clinic.