心尖肥厚型心肌病的临床特点及预后分析

Analysis of the clinical characteristics and prognosis of the apical hypertrophic cardiomyopathy

目的：探讨心尖肥厚型心肌病（ AHCM ）的临床特点及预后。方法回顾性分析34例AHCM患者的临床资料，分析其临床特点、ECG及影像学资料、心血管事件发生率。结果心尖肥厚型心肌病临床表现无特异性，左室高电压及左胸前导联巨大倒置T波为ECG特征性改变；34例中经超声心动图检查确诊21例，MRI检查确诊13例；随访期间发生心血管事件4例（11．8％），末次随诊左室心尖部厚度、左室心尖厚度/左心室后壁厚度与首次诊断时比较，差异有统计学意义（t＝-3．73、-3．908，均P＜0．05）；左心室射血分数、室间隔厚度、左室舒张末期内径、左室后壁厚度等与首次诊断比较，差异无统计学意义（ t＝1．762、1．662、-1．857、2．015，均P＞0．05）。结论心尖肥厚型心肌病预后较好，误诊率较高，临床医生应提高该病认识水平，特征性ECG改变及超声心动图、MRI检查有助于确诊。

Objective To explore the clinical characteristics and prognosis of apical hypertrophic cardiomy -opathy （AHCM）.Methods A retrospective analysis was performed on the clinical data of 34 patients with AHCM, the clinical characteristic , ECG, imageology data and the cardiovascular morbidity were counted and analyzed . Results There was no specificity on the clinical characteristics of the patients with AHCM ,the high voltage of the left ventricular and the huge inverted T wave of the left precordial leads came into the characteristic change for the ECG,there were 21 patients of the total 34 patients were made a definite diagnosis after examined by the ultrasonic cardiogram,13 patients of them were made a definite diagnosis after examined by MRI .During the following-up,there were 4 patients occurred angiocardiopathy （the morbidity was 11.8%）.The thickness of apex,apex cordis and poste-rior wall of the left ventricle examined during the last follow-up had significant differences compared with that during the first diagnosis（t=-3.73,-3.908,all P＆lt;0.05）.The left ventricular ejection fraction ,interventricular septal thickness,left ventricular end diastolic diameter and thickness of the posterior wall of left ventricle had no significant differences compared with that during the first diagnosis （t =1.762,1.662, -1.857,2.015,all P ＆gt;0.05）. Conclusion AHCM has the benign prognosis effect , but the clinical misdiagnosis rate is high , clinicians should enhance their understanding level on the disease ,the characteristic ECG change ,ultrasonic cardiogram and MRI check can help to make a definite diagnosis .