老年肥厚型心肌病与高血压左室肥厚患者临床特点的比较

Comparison of clinical characteristics between hypertrophic cardiomyopathy patients and hypertension patients with left ventricular hypertrophy in the elderly

目的分析老年肥厚型心肌病与老年高血压左室肥厚患者的临床特点。方法回顾性分析老年肥厚型心肌病患者（35例）与老年高血压左室肥厚患者（35例）的症状和体征及心电图、超声心动图的差异。结果老年肥厚型心肌病患者均无高血压史。两组年龄、性别、脑血管病史及肥厚型心肌病家族史比较，差异均无统计学意义（均为P〉0．05）。老年肥厚型心肌病患者中，晕厥者5例（14．3％），高血压左室肥厚患者中，无晕厥者，2组比较，差异有统计学意义（P〈0．05）。老年肥厚型心肌病患者中无心脏杂音者9例（25．7％），明显少于高血压左室肥厚患者[23例（65．7％），P〈0．05]。心电图示：老年肥厚型心肌病患者中，有异常Q波者10例（28．6％），较高血压左室肥厚患者的1例（2．9％）多（P〈0．05）。老年肥厚型心肌病患者中心房颤动（房颤）及STT改变者分别为11例（31．4％）及34例（97．1％），明显多于高血压左室肥厚患者的3例（8．6％）及26例（74．3％），均为P〈0．05。超声心动图示：老年肥厚型心肌病患者的左室后壁厚度为（9．5±1．1）mm，明显薄于高血压左室肥厚患者的（12．6±1．0）mm（P〈0．01），左房内径老年肥厚型心肌病患者为（41．6±6．3）mm，高血压左室肥厚患者为（38．6±5．5）mm，两组差异有统计学意义（P〈0．05）；老年肥厚型心肌病患者二尖瓣血流频谱E／A〈1者15例（42．9％），明显少于高血压左室肥厚患者的32例（91．4%），P〈0．05。老年肥厚型心肌病患者有主动脉瓣钙化者7例（20．0％），高血压左室肥厚患者20例（57．1％），二者差异有统计学意义（P〈0．05），室间隔厚度、左室内径与射血分数2组相似（均为P〉0．05）。结论老年肥厚型心肌病患者临床表现有晕厥者多，心脏有明显的杂音，心电图有异常Q波及房颤者较多，超声心动图显示左室不对称性肥厚多；高血压左室肥厚患者左室肥厚多为对称性，合并主动脉瓣钙化者多。

Objective To investigate the clinical and echocardiographic features between hypertrophic cardiomyopathy patients （HCM group） and hypertension patients with left ventricular hypertrophy （H-LVH group） in the elderly. Methods In all the patients aged 60 years and over, the clinical characteristics, electrocardiographic and echocardiographic records in 35 patients with hypertrophic cardiomyopathy （no hypertension history）, 35 patients with hypertension and left ventricular hypertrophy were retrospectively analyzed. Results （1） A higher incidence of syncope was found in group HCM （14.3%） compared with group H-LVH（0%） ,P〈0.05. In group H-LVH, there were more patients without cardiac murmurs than in group HCM（65. 7% vs. 25. 7%, P〈0. 05） . No significant differences existed in symptoms, signs and cardiac function class between group H-LVH and group HCM（all P）0.05）. （2） In ECG, higher incidences of atrial fibrillation, abnormal Q waves and no-specific ST-T changes were found in group HCM compared with group H-LVH （31.4% vs. 8. 6%, 28.6% vs. 2. 9%, 97. 1% vs. 74.3% respectively; all P〈O. 05 respectively）. （3） In comparison of group HCM versus group H-LVH, left ventricular posterior wall （LVPW） thickness was thinner [（9.5±1.1） vs. （12.6±1.0）mm], the frequency of E/A〈1 was lower （42.9% vs. 91.4%） left atrium dimension was bigger[（41.6±6.3） mm vs. （38.6±5.5）mm],the frequency of calcified aortic valves was lower（20.0 % vs. 57.1 %）. No significant differences in mitral annular calcification and EF values were found between group H-LVH and group HCM（P〉0.05 respectively）. Conclusions More HCM patients in the elderly have syncope symptom, heart murmur and abnormal Q wave in ECG compared with hypertension patients with left ventricular hypertrophy. Left ventricle of HCM patients is dissymmetrical, while left ventricle of hypertension patients is symmetrical, and has more calcific aortic valves.