肥厚性心肌病心尖肥厚亚型的临床诊断(附28例临床报告)

Diagnosis of apical hypertrophic cardiomyopathy: A clinical report with 28 cases

目的对心尖肥厚型心肌病的辅助诊断进行探讨。方法以心电图、超声心动图、放射核素心肌断层显像、冠状动脉造影及左室造影等检查方法，诊断２８例心尖肥厚型心肌病。结果２８例心电图显示胸导联倒置的Ｔ波呈ＴＶ４＞ＴＶ５的关系；超声心动图左室心尖部（乳头肌水平以下）心肌肥厚达１２ｍｍ以上；１８例行放射核素心肌断层显像见左心室心尖部心肌肥厚；２０例左心室造影均提示心尖部心肌肥厚、冠脉造影正常，其中１１例左心室舒张末期呈“黑桃”样改变。结论标准１２导联心电图显示胸导联倒置的Ｔ波伴Ｒ波振幅增高，而不伴有高血压病史者，应高度注意心尖肥厚型心肌病的诊断。

Objective The purpose of the study was to evaluate the value of ECG as compared with two dimensional echocardiography for a reliable assessment of the clinical diagnosis of apical hypertrophic cardiomyopathy (AHCM).Methods and Results 28 cases (22 males, 6 females, mean age 51.50±13.45 years) with AHCM were studied by ECG, echocardiography, radionuclide 99mTc MIBI myocardial scanning, coronary angiography and left ventriculography (LVG). ECG showed giant T wave inversion in chest leads. The amplitudes of inverted T wave were in the pattern or T V4 >T V5 . Left ventricular wall thickness measured by echocardiography were≥12mm in apex in 28 cases. Radionuclide myocardial scanning suggested apical hypertrophy in 18 cases. LVG demonstrated apical hypertrophic cardiomyopathy with normal coronary angiogram in 20 cases, 11 of which had the apical “spade” changes. Conclusion The character of inverted T waves of T V4 >T V5 in ECG is of major value on clinical diagnosis of those with AHCM.