特发性扩张型心肌病合并左心室室壁瘤形成的临床分析  

Clinical study of idiopathic dilated cardiomyopathy complicated by left ventricniar aneurysm

作　　者：夏淑东[1] 吴必锋[1] 金建美[1] 陈君柱[1] 

机构地区：[1]浙江大学医学院附属第一医院心内科,杭州310003

出　　处：《中华心血管病杂志》2009年第4期314-319,共6页Chinese Journal of Cardiology

摘　　要：目的观察特发性扩张型心肌病（idiopathic dilated cardiomyopathy，IDCM）合并左心室室壁瘤（1eft ventricular aneurysm，LVA）形成的发生率及其血液动力学和心脏电生理的特点。方法回顾我院2003年至今诊断为IDCM的患者的病历资料，经冠状动脉造影排除缺血性心肌病同时经左心室造影证实合并LVA形成者入选为研究组。随机入选12例性别、年龄及左心室内径大小匹配的IDCM患者作为对照组。两组的临床资料和检查结果进行对比分析。结果998例IDCM患者中有6例患者证实同时合并LVA形成，发生率为0．60％。研究组的左心室收缩期最大压力显著高于对照组[（130±10）mmHg（1mmHg=0．133kPa）比（117±9）mmHg，P〈0．05]。研究组左心室舒张末期容积显著高于对照组[（272±57）ml比（207±60）ml，P〈0．05]。研究组左心室射血分数略低于对照组[（27±9）％比（35±6）％，P=0．09]。室性心律失常在研究组的发生率更高。结论IDCM合并LVA在临床上较为少见。合并LVA的IDCM患者左心室舒张末期容积增大，左心室收缩期压力升高，而左心室收缩功能下降，更容易发生室性心律失常。Objective To examine the hemodynamic and electrophysiological influence of left ventricular aneurysm （LVA） formation in patients with idiopathic dilated eardiomyopathy （IDCM）. Methods All hospital records were retrospectively reviewed from IDCM patients admitted to our hospital between 2003 and 2008. Patients with coronary angiography evidenced ischemic cardiomyopathy were excluded. IDCM patients with LVA （ I ＋ L） diagnosed by left ventriculography were enrolled. Twelve age-, gender- and leftventricular-diameter- matched patients with IDCM without LVA served as control group （ I - L）. Results Six out of 998 patients with IDCM were confirmed to have LVA （ 0. 60% ）. The LV peak-systolic pressure was higher in the I ＋ L group than in I - L group [ （ 130 ± 10） mm Hg（ 1 nun Hg = 0. 133 kPa） vs. （ 117± 9） mm Hg, P 〈 0. 05 ]. The LV end-diastolic volume was significantly larger in the I ＋ L group than in I-L group[ （272 ±57）ml vs. （207 ±60）ml, P〈0. 05]. The LV ejection fraction was slightly lower in the I ＋L group than in I - L group [ （ 27 ±9 ） % vs. （35± 6 ） %, P = 0. 09 ]. Ventricular arrhythmia occurred more frequently in I ＋ L group than in I - L group. Conclusion LVA formation in IDCM was a rare phenomenon. IDCM patients with LVA seem to have higher LV peak-systolic pressure, larger end-diastolic volume, worse LV systolic function and more frequent ventricular arrhythmia than those without LVA.

关 键 词：心肌病 扩张型 心脏室壁瘤 心律失常 

分 类 号：R686[医药卫生—骨科学]