孤立性左心室心肌致密化不全与特发性扩张型心肌病超声心动图特征的对比分析  

Comparison of Echocardiographic Features of Isolated Noncompaction of Left Ventricular Myocardium Versus Idiopathic Dilated Cardiomyopathy

作　　者：宋则周[1] 马静[2] 

机构地区：[1]浙江大学医学院附属第一医院超声科,杭州市310003 [2]杭州市第三医院

出　　处：《中国超声诊断杂志》2006年第7期490-493,共4页Chinese Journal of Ultrasound Diagnosis

摘　　要：目的对比分析孤立性左心室心肌致密化不全(INCLVM)与特发性扩张型心肌病(IDCM)的超声心动图特征,探讨二者的鉴别诊断标准。方法10例INCLVM和15例IDCM患者行常规超声心动图检查二维超声测定室间隔与左室后壁基底段厚度、左室前后径(D)与左室长径(L)比值、左房前后径(LAd),双平面Simpson方法计算左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、左室射血分数(LVEF);彩色多普勒血流显像评价各瓣膜口反流及程度;脉冲多普勒测定二尖瓣血流图评价左室舒张功能状况。将左室室壁分为9个节段,应用目测法确定肥大肌小梁所在节段及运动减弱节段。分别测定收缩末期和舒张末期心尖段肥大肌小梁厚度(Tt)与室壁厚度(Tw)比值。结果尽管INCLVM与IDCM患者球形重构(D/L)的程度是相似的,但是与IDCM患者相比,INCLVM患者具有更厚的室壁厚度,更小的LAd、LVESV和LVEDV,更高的LVEF,更低的二尖瓣反流及程度,更好的左室舒张功能状况。与IDCM患者相比,INCLVM患者肥大肌小梁所在节段分布范围较广、数目较多,而运动减弱节段则较少。收缩末期Tt/Tw较舒张末期Tt/Tw可以更准确地对IDCM与INCLVM进行鉴别诊断。结论INCLVM与IDCM超声心动图特征具有较多差异,综合考虑各个差异有助于对两者进行准确的鉴别诊断。Objective To compare echocardiographic features of isolated noncompaction of the left ventricular myocardium （INCLVM） versus idiopathic dilated cardiomyopathy （IDCM） and to investigate their differential diagnosis. Methods Echocardiographic examinations were performed in 10 patients with INCLVM and 15 patients with IDCM ： the basal thickness of interventricular septum and left ventricular posterior wall, the ratio of （D） and longitudinal diameter （L） of the left ventricle, anteroposterior diameter of left atrium （LAd） were measured on two-dimensional echocardiography. End-systolic volume of the left ventricle （LVESV）, End-diastolic volume of left ventricle （LVEDV） and ejection fraction of left ventricle （LVEF） were obtained using Simpson rule. The regurgitation of all the valves and their degrees were assessed by color Doppler flow imaging. The left ventricular diastolic function was evaluated by mitral flow pattern of pulsed Doppler echocardiography. The segments of hypertrophic myocardial trabeculations and hypokinetic myocardium in all 9 segments of the left ventricle were assessed by naked eye. The Ratio of the thickness of hypertrophic myocardial trabeculations （Tt） and myocardial wall （Tw） at the same point were obtained at end-systolic and end-diastolic, respectively. Results In spite of the similar sphericity reconstruction, the thickness of left ventricular wall was thicker, LAd, LVESV and LVEDV were smaller, LVEF was higher, mitral regurgitation and their degrees were lower and the left ventricular diastolic function was better in patients with INCLVM compared with IDCM. The segments of hypertrophic myocardial trabeculations were more and the segments of hypokinetic myocardium were fewer in patients with INCLVM than patients with IDCM. The ratio of Tt and Tw at end-systolic was accurate than that at end-diastolic in differential diagnosis. Conclusions Echocardiographic features of INCLVM and IDCM have many differences. Combined consideration could contribute to

关 键 词：充血性心肌病 心肌致密化不全 超声心动描记术 

分 类 号：R542.2[医药卫生—心血管疾病] R544.1[医药卫生—内科学]