扩张型心肌病的超声心动图诊断及鉴别诊断

Value of echocardiography in the diagnosis and differentiated diagnosis of dilated cardiomyopathy

目的探讨超声心动图对扩张型心肌病(dilated cardiomyopathy,DCM)的诊断价值及误诊分析。方法对92例临床确诊或冠状动脉造影排除的DCM患者,进行超声声像图分析。结果①92例中,87例超声诊断为DCM,声像图表现为房室腔扩大,室壁弥漫性运动减弱,多瓣膜反流,收缩功能显著减低;5例超声提示左室壁节段性运动异常,后由冠状动脉造影术排除冠状动脉病变;②92例DCM患者中,发生左心室血栓者27例,其中12例表现为低回声团块(较新鲜)、9例等回声光团、6例偏高/高回声团块(陈旧性);经溶栓药物治疗6个月后复查,24例血栓完全消失、2例明显缩小、1例无明显变化。结论①超声可客观显示DCM患者心脏形态及血流动力学改变,是临床诊断DCM的首选检查方法;②DCM病变累及传导系统可致心肌激动顺序改变,出现室壁节段性运动异常,冠状动脉造影术有助于DCM与缺血所致心肌病变的鉴别;③超声心动图诊断心腔血栓无创、快捷、准确,能直接显示血栓位置、大小、形态、数目、活动与否,对临床溶栓治疗效果评估具有重要意义。

Objective To discuss the diagnosis and differentiated diagnosis value of dilated cardiomyopathy（DCM）.Methods Analysis was performed in 92 patients with DCM confirmed through clinical and coronary arterion-graphy.Results 1） Among the 92 patients,87 patients had global leftventricle dilatation,diffuse wall motion abnormalities,valvuae regurgitation and hypokinesis;5 patients had leftventricle dilatation abnormalmotion.2） The left ventricle thrombus were detected in 27 cases,including low level echo masses in 12 cases,equal echo masses in 9 cases and high level echo masses in 6 cases.After treatment with thrombolytic drug for 6 months,reexamination showed 24 thrombus disappevared,2 thrombus deflated obviously,only 1 thrombus had no change.Conclusion 1） Ultrasonography can reveal peripheral heart disease and hemodynamics changed objectively in patients with DCM,which is the first line imaging modality clinically.2） Conduction system of patient＇s heart was involved sothat had leftventricle dilatation abnormalmotion.Coronary arteriongraphy could play an important role in differertial diagnosis of DCM.3） Ultrasonography is a non-invasive,fast and accurate technique.The number and size of thrombus are well displayed through ultrasonography,thus it is helpful for diagnosing and treating DCM.