左心室造影对老年心尖肥厚型心肌病患者的诊断价值分析

The value of left ventricular angiography in the diagnosis of apical hypertrophic cardiomyopathy

目的探讨左心室造影对老年心尖肥厚型心肌病患者的临床诊断价值。方法连续人选我院2016年6月至2017年12月常规超声心动图检查心尖部显示不清可疑为心尖部肥厚型心肌病或不能排除心尖部肥厚型心肌病的老年患者32例观察性分析，年龄61～78岁，进行左心室心腔造影，左心室心尖部肥厚，心尖部肥厚部位〉1．5cm且肥厚部位与非肥厚部位之比〉1．3，其余部位心肌无肥厚为左心室心尖部肥厚型心肌病诊断标准。结果32例患者中，确诊心尖肥厚型心肌病24例（75．o％），均为单纯心尖部肥厚；8例排除肥厚型心肌病，心尖部厚度正常。心尖肥厚型心肌病患者中，心尖部厚度15～21mm，心尖部肥厚心肌均运动幅度减低，部分室壁回声不均匀。所有病例造影后心尖部显示率100％，心尖肥厚型心肌病患者心尖部心肌肥厚，心尖部心腔失去正常形状，呈尖顶征；部分心尖部心室腔闭塞或心尖部厚度不均匀。结论左心室造影可作为常规超声心动图对心尖部肥厚型心肌病的补充诊断方式，更清晰心内膜轮廓，更准确测定心尖部室壁厚度，可提高超声对心尖肥厚型心肌病的诊断价值。

Objective To assess the diagnostic value of left ventricular angiography in patients with apical hypertrophic cardiomyopathy. Methods A total of 32 consecutively recruited patients aged from 61 to 78 with suspected apical hypertrophic cardiomyopathy from inconclusive apex imaging on conventional echocardiography from June 2016 to December 2017 underwent left ventricular opacification. A diagnosis of apical hypertrophic cardiomyopathy was made when the thickness of hypertrophied area of the apex was 〉 1.5 cm, the ratio of the hypertrophied area to the non- hypertrophied area was 〉 1.3, and no hypertrophy was found elsewhere. Results Twenty-four out of 32 patients （75.0%） were diagnosed with apical hypertrophic cardiomyopathy, all of whom had pure apical hypertrophy. The other 8 patients were excluded, with normal thickness in the apex. Patients with apical hypertrophic cardiomyopathy had apical wall thicknesses ranging from 15 mm to 21 mm,reduced myocardial motion amplitude in the apex and uneven echo at certain areas of the ventricular wall. All cases showed clear images of the apex with left ventricular opacification, and the apex of the heart lost its normal morphology and showed a pointed end, with ventricular cavity obliteration or uneven wall thickness in the apex. Conclusions Left heart ventricular angiography can be complimentary to conventional echocardiography in the diagnosis of apical hypertrophic cardiomyopathy by providing a clearer endocardial contour and more accurate estimates of apical wall thickness and therefore enhancing the diagnostic value of ultrasound for apical hypertrophic cardiomyopathy.