超声心动图结合心电图特征对扩张型心肌病与缺血性心肌病的鉴别诊断

Differential diagnosis of DCM and ICM with echocardiography and electrocardiogram

目的探讨超声心动图(ultrasonic cardiogram,UCG)结合心电图(electrocardiogram,ECG)特征对扩张型心肌病(dilated cardiomyopathy,DCM)和缺血型心肌病(ischemic cardiomyopathy,ICM)的诊断与鉴别诊断价值。方法根据冠脉造影结果,对30例DCM及30例ICM的超声形态学与心电图特征进行回顾性分析比较。结果ICM组与DCM组各项指标间均有显著性差异(P<0.05或P<0.01)。其特点为:DCM组心脏多个房室腔扩大呈球形结构,室壁变薄及弥漫性运动度减弱;ICM组心脏以左房室扩大为主,多呈葫芦状,室壁节段性运动减弱。DCM组以收缩功能降低为主,舒张功能可表现为正常;而ICM组以舒张功能降低为主,收缩功能可表现为正常。DCM组多瓣膜返流发生率较高且程度较重,ICM组多为单瓣膜返流且程度较轻。DCM组Rv6/Rmax≥3.0占71.2%(Rmax为Ⅰ、Ⅱ、Ⅲ导联中振幅最大的R波),而ICM组却无一例。结论超声心动图结合心电图特征是对DCM与ICM进行鉴别的简便可靠的方法。

[Objective] To investigate the diagnostic and differential diagnostic value of ultrasonic cardiogram （UCG） and Electrocardiogram（ECG） in patients with dilated cardiomyopathy （DCM） or ischemic cardiomyopathy （ICM）. [Methods] According to the characteristics of the coronary angiography, the echocardiographic morphology and electrocardiogram features of 30 cases with DCM and 30 cases with ICM were reviewed retrospectively. [Results] The findings showed that the multichambers of the heart enlarged, the ventricular wall became thin and its motion decreased in DCM; In DCM, the systolic function of the left ventricle decreased and its diastolic function was normal, but in ICM, the systolic function of the left ventricle was normal and its diastolic function decreased significantly; The occurrence rate of valvularregurgitation was much higher and its degree was more severe in DCM than in ICM; Rv6/Rmax≥3.0（Rmax represents R wave of aximum amplitude among lead of Ⅰ, Ⅱ, Ⅲ） in DCM group was more than that of ICM group, and Rv6/Rmax≥3.0 is 71.2%. [Conclusions] It is suggested that echocardiography and electrocardiogram are simple and valuable method of differential diagnosis of ischemic cardiomyopathy and dilated cardiomyopathy.