左心室心尖部室壁增厚特征与心电图T波倒置关系分析

Association Between the Hypertrophic Patterns of the Left Ventricular Apical Wall Thickening and Voltage of Negative T Wave

目的:探讨左心室心尖部室壁增厚且心电图胸前导联出现无法解释的广泛T波倒置患者的室壁增厚特征与心电图T波倒置的关系。方法:连续入选91例超声心动图提示左心室心尖部室壁增厚且心电图胸前导联广泛T波倒置的患者,包括53例典型心尖肥厚型心肌病(AHCM)患者(典型AHCM组)、25例早期AHCM患者(早期AHCM组)、13例可疑AHCM患者(可疑AHCM组)。在典型AHCM组与早期AHCM组中共有单纯型29例,混合型49例。测量各导联T波倒置的深度(T)及T波倒置的最大深度(Tmax),测量心尖部各室壁厚度及最大厚度(APWTmax)并计算其与左心室后壁厚度的比值(ABR)。结果:各组间心电图上T波倒置的导联分布、最大深度及胸前导联T波倒置的深度之和比较差异无统计学意义。在78例典型和早期AHCM患者中,心尖厚度与T波深度无明显相关性,但在其中的29例单纯型患者中,APWT max分别与TV5(r=0.381)及Tmax(r=0.416)弱相关;而在49例混合型及13例可疑AHCM患者中心尖厚度与T波深度也无明显相关。结论:在左心室心尖肥厚程度与T波深度关系上,只有单纯型AHCM患者的APWTmax与T波深度弱相关,而在混合型AHCM患者中二者无明显相关性。

Objectives:This study aimed to analyze the relationship between hypertrophic patterns of the left ventricular apical wall thickening and the voltage of negative T wave.Methods:A total of 91 consecutive patients,who admitted to our hospital from 2015 to 2018,with T-wave inversion and left ventricular apical hypertrophy or thickened apex were enrolled into this study.Patients were classified into three groups:53 typical apical hypertrophic cardiomyopathy(T-AHCM),25 pre-AHCM(P-AHCM)and 13 suspected AHCM(S-AHCM).There were 29 pure AHCM and 49 mixed AHCM among the T-AHCM and P-AHCM patients.Voltage of negative T wave,maximal voltage of negative T wave in 12 leads(Tmax)were measured.Apical morphology measurements included thickness of septum,anterior wall,lateral wall and posterior wall in apical,maximal apical wall thickness(APWTmax),and apical to basal posterior wall thickness ratio(ABR).Results:No significant correlation was found between magnitude of apical hypertrophy and depth of T wave among the 78 cases with P-AHCM and T-AHCM,however,there were weak correlations between APWTmax and TV5(r=0.381)and between APWTmax and Tmax(r=0.416)in 29 patients with pure AHCM.There was no correlation between magnitude of apical hypertrophy and depth of T wave in the 49 mixed AHCM and 13 S-AHCM.Conclusions:The maximal apical wall thickness correlated with the voltage of negative T wave only in patients with pure AHCM,not in mixed AHCM.