超声心动描记术在心尖肥厚型心肌病诊断中的应用及评估

Application and evaluation of echocardiography in diagnosing apical hypertrophic cardiomyopathy

目的分析心尖肥厚型心肌病(apical hypertrophic cardiomyopathy,AHCM)的超声心动描记术特征及可能的漏诊原因,探讨超声心动描记术对临床诊断AHCM的应用价值。方法收集笔者所在医院45例AHCM患者影像学检查资料,包括超声心动描记术45例、心电图45例、冠状动脉造影10例及左心室造影结果 4例,进行分析。结果 (1)41例患者的超声心动描记术像显示左心室心尖部心肌明显增厚;4例超声心动描记术结果正常者,行左心室造影显示左心室舒张末期心尖部室壁肥厚,呈"黑桃征",最后诊断AHCM。(2)41例超声图像表现为AHCM的患者中,17例收缩期左心室腔心尖部狭小、几乎呈闭塞状;5例患者左心室腔中部梗阻,其平均压力梯度为(59.1±10.9)mm Hg(1 mm Hg=0.133 kPa)。(3)10例行冠状动脉造影检查的AHCM患者中,2例合并冠状动脉中重度狭窄并行支架植入术,2例左冠状动脉前降支中段可见心肌桥,6例冠状动脉正常。结论典型超声心动描记术表现,结合特征性心电图,有助于临床确诊。将心尖部左心室短轴切面作为常规扫查切面,特别对心电图有特异性改变的患者(如心前区导联V4-6导T波对称性深倒),结合彩色多普勒血流充盈情况判断心内膜边界,可明显提高检出率。超声心动描记术可为临床诊断AHCM提供重要依据,是协助临床明确诊断、积极治疗、判断预后的首选检查方法。

Objective To analyze the features of echocardiography（UCG） and the possible reason of misdiagnosis in patients with apical hypertrophic cardiomyopathy（AHCM）,so as to evaluate its application value.Methods Authors retrospectively reviewed the imaging examination datas of 45 patients with AHCM,including 45 UCG,45 ECG,10 coronary angiography（CAG） and 4 left ventriculography. Results 1）UCG showed 41 AHCM patients with apical myocardium obviously thicken（16-32 mm）,and 4 being normal but whose left ventricular angiography revealed a spade-like shaped left ventricular which was representative of apical hypertrophic cardiomyopathy. 2）In 17 patients with AHCM,the thickened apical segments became a crowded small apical cavity with obliteration of the apex during systole among thena 5 had the left mid-ventricular obstruction and their average pressure gradient was（59.1±10.9） mm Hg. 3）In 10 cases subject to CAG 2 were complicated with coronary heart disease,2 with coronary artery muscular bridge at left anterior descending（LAD） artery,rest 6 were normal. Conclusions 1）Typical UCG performance combined with the character ECG is helpful to diagnose AHCM. The apex of left ventricular short axis section is helpful to find the myocardial hypertrophy,specially in those patients who have an abnormal ECG,such as the character of inverted T waves of Tv4-6. The color Doppler ultrasound is useful to judge the endocardial boundary and it can obviously improve the detection rate.2）UCG can provide important information for the appropriate diagnosis of AHCM patients. UCG is the main method of diagnosing AHCM and has important clinical value in early and accurate diagnosis.