心尖顶角与射血速度诊断心尖肥厚型心肌病的应用价值

Application value of apical vertex angle and ejection velocity in diagnosis of apical hypertrophic cardiomyopathy

目的探讨心尖局部形态与动力学特征对于诊断心尖肥厚型心肌病(AHCM)的应用价值。方法选择51例AHCM,包括21例早期AHCM(P-AHCM组)和30例典型AHCM(T-AHCM组);以40名健康志愿者(NC组)及44例单纯高血压左心室重构患者(HT组)作为对照,超声观察舒张末期和收缩末期心尖顶角(θap)及其收缩期变化率(△θap)、收缩期心尖峰值射血速度(V ap)及其与左心室流出道射血速度的比值(速度指数V ap/V LVOT)等。结果相比NC组及HT组,P-AHCM组和T-AHCM组θap均变小(P均<0.001),△θap、V ap增大(P均<0.001)。结论超声心动图可于早期阶段检出AHCM所致心尖顶角减小、局部射血速度及收缩期角度变化率增高,结合特异性心电图改变有望提高超声对AHCM的检出率。

Objective To observe the application value of apical vertical angle and ejection velocity in diagnosis of apical hypertrophic cardiomyopathy(AHCM).Methods A total of 51 patients with AHCM,including 30 typical AHCM(T-AHCM group)and 21 pre-AHCM(P-AHCM group)were enrolled.Forty matched healthy volunteers and 44 hypertensives were recruited as normal control(NC group)and hypertension group(HT group),respectively.Echocardiographic studies were performed in all subjects to acquire and analyze apical vertical angle(θap)and its systolic rate of change(△θap)in end diastolic and end systolic stage,peak ejection velocity(V ap)in systolic stage and its ratio to the velocity in left ventricular outflow tract(V LVOT).Results Compared with NC and HT groups,θap decreased and△θap and V ap increased significantly in both P-AHCM and T-AHCM groups(all P<0.001).Conclusion Decreased apical vertical angle and systolic rate of angle change and local ejection velocity are found in patients with AHCM even in early stage.Combination of these indicators with specific ECG changes are expected to improve the detection rate of AHCM with ultrasound.