肥厚型心肌病的经胸超声心动图诊断与心电图表现特征

Transthoracic echocardiographic and electrocardiographic features of hypertrophic cardiomyopathy

目的:探讨肥厚型心肌病的经胸超声心动图诊断与心电图表现特征。方法:回顾性选取2021年9月至2023年9月在湖北省咸宁市中心医院经超声心动图诊断为肥厚型心肌病的患者110例。所有患者于超声心动图检查的同时记录完整12导联心电图。分析不同表型肥厚型心肌病的经胸超声心动图参数测量结果及心电图表现特征。结果:110例患者中,心尖肥厚型心肌病22例,非梗阻性肥厚型心肌病67例,梗阻性肥厚型心肌病21例。超声心动图结果显示梗阻性肥厚型心肌病室间隔厚度大于其他两种类型,左心室舒张末期内径小于其他两种类型;心尖肥厚型心肌病室间隔厚度和左心室后壁厚度小于其他两种类型;左心室射血分数3种表型差异不明显。心尖肥厚型心肌病心电图以ST-T改变、V4-V6导联巨大倒置的T波和左心室高电压为主要表现,占比分别为95.42%、66.63%和72.72%;非梗阻性肥厚型心肌病心电图表现ST-T改变多见,占比25.33%;梗阻性肥厚型心肌病心电图以ST-T改变和病理性Q波、左心室高电压为特征,占比分别为90.74%和19.42%、19.42%,合并心房颤动的比例也明显高于其他表型的肥厚型心肌病。110例肥厚型心肌病中,心电图诊断肥厚型心肌病93例(93/110,84.5%),但是无法对不同表型的心肌肥厚进行分型。结论:不同表型肥厚型心肌病心电图表现特征存在差异,但不具有特异性,及时进行超声心动图检查,有助于提高肥厚型心肌病的检出率,同时也可以对不同表型的肥厚型心肌病进行精确诊断,为临床制定不同的治疗方案提供客观的依据。

ObjectiveTo investigate the transthoracic echocardiographic and electrocardiographic features in patients with hypertrophic cardiomyopathy.MethodsOne hundred and ten patients with hypertrophic cardiomyopathy diagnosed by echocardiography at Xianning Central Hospital of Hubei Province from September 2021 to September 2023 were retrospectively selected. All patients had complete 12 lead electrocardiogram (ECG) recorded after echocardiography was performed. The parameters of transthoracic echocardiography and electrocardiographic characteristics of hypertrophic cardiomyopathy with different phenotypes were analyzed.ResultsOne hundred and ten cases of hypertrophic cardiomyopathy were diagnosed by echocardiography, including 22 cases of apical hypertrophic cardiomyopathy (AHCM), 67 cases of non-obstructive hypertrophic cardiomyopathy (HCM) and 21 cases of obstructive hypertrophic cardiomyopathy (OHCM). Echocardiography showed that the interventricular septal thickness in patients with OHCM was significantly greater than that of patients with AHCM and HCM. The left ventricular end diastolic diameter in OHCM patients was smaller than that of AHCM and HCM patients. The interventricular septal thickness and left ventricular posterior wall thickness in AHCM patients were significantly smaller than those of OHCM and HCM patients. The left ventricular ejection fraction was not significantly different among the three phenotypes. The ECG in AHCM patients mainly showed ST-T changes, giant inverted T waves in lead v4-v6, and high left ventricular voltage, which accounted for 95.42%, 66.63%, and 72.72% of cases, respectively. ST-T wave changes were more common in HCM patients, accounting for 25.33% of cases. The ECG of OHCM patients was characterized by ST-T changes, pathological Q wave, and left ventricular high voltage, which accounted for 90.74%, and 19.42%, 19.42% of cases, respectively. The proportion of patients with atrial fibrillation was significantly higher in OHCM patients than in those with other phenotypes of hypertrophic cardiomyopathy. Among 110 cases of hypertrophic cardiomyopathy, 93 (93/110, 84.5%) were diagnosed by ECG, though it was impossible to classify different phenotypes of cardiac hypertrophy by this modality.ConclusionThe ECG features of hypertrophic cardiomyopathy with different phenotypes are different, but they are not specific. Timely echocardiography is not only helpful to improve the detection rate of hypertrophic cardiomyopathy, but it can also accurately diagnose hypertrophic cardiomyopathy with different phenotypes, thus providing an objective basis for clinical dicision-making.