心尖部肥厚型心肌病的影像学诊断特点  

Imaging features of the apical hypertrophic cardiomyopathy

作　　者：吴颖[1] 张励庭[1] 黄炫生[1] 袁勇[1] 

机构地区：[1]中山市人民医院心内科,广东省528403

出　　处：《中国心血管病研究》2011年第3期206-209,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨心尖部肥厚型心肌病影像学检查特点,总结更为合理的诊断和治疗方法.方法 回顾性分析我院2004年1月至2010年1月期间60例诊断为心尖部肥厚型心肌病患者的临床表现,心电图、超声心动图、冠状动脉造影、左室造影、256层螺旋CT及心脏磁共振检查的特点,以及治疗后随访1年的心血管事件.结果 60例患者中56例表现为V1～V6导联 ST段压低,T波倒置,尤以V4 T波深倒;1例为完全性右束支传导阻滞;2例表现为AVR抬高,V3～V6导联ST段压低,T波倒置;1例Ⅲ、V1 T波倒置,V2～V6 T波双向.超声心动图异常改变48例（80%）,其中38例表现为不同程度的心尖部肥厚,厚度均≥15 mm,最厚可达22～24 mm.冠脉造影41例,仅有1例为前降支中段狭窄约70%,2例为前降支近中段肌桥形成,其余38例冠脉血管均正常.左室造影32例表现为左室腔舒张末期呈＂黑桃＂形改变,9例表现为＂猫舌＂状.10例患者行256层心脏及冠脉CTA检查,2例发现前降支近中段肌桥,8例冠脉正常;10例患者表现为心尖部增厚,厚度为15～21 mm.9例患者行心脏磁共振（CMR）检查,7例发现心尖部肥厚,厚度14～28 mm.结论 心尖部肥厚型心肌病容易误诊为冠心病.结合心电图和超声心动图可进一步明确,左心室造影、多层螺旋CT及心脏MRI为该病的诊断提供了确诊的依据.Objective To analyze the imaging features of the apical hypertrophic cardiomyopathy （AHC）, and explore the reasonable diagnosis and treatment method. Methods Retrospectively analysis the characters of inspections for 60 cases with AHC during Jan. 2004 to Jan. 2010, including electrocardiography, e- chocardiography, coronary angiography and left venticulography, 256-＇sliced spiral CT and magnetic resonance im- age （MRI）. And conclude the results of one year follow-up. Results Electrocardiography showed wave amplitude of V1-V6 in chest leads increased and was accompanied by symmetry and deeply inverted T wave in 56 patients. 48 cases were confirmed by echocardiography, and showed apical hypertrophy more than 15 mm, the largest is 22-24 ram. Coronary angiography were perfomed in 41 cases, and showed LAD stcnosis in only one case, 2 cases were found myocardial bridge in mid-LAD, and 38 cases are normal. 41 cases were confirmed by left ventriculography. 256-sliced CT were performed in 10 cases, and showed normal coronary in 8 cases, 2 cases with myocardial bridge in LAD. Cardial magnetic resonance image were performed in 9 cases, and showed apical hypertrophy in 7 cases, average 14-28 ram. Conclusion Characteristic changes of electrocardiography and echocardiography provide primary evidence for diagnosis of apical hypertrophic cardiomyopathy. Besides, left ventriculography, multi-sliced CT and Cardiac magnetic resonance image are feasible diagnosis methods.

关 键 词：心肌病 肥厚型 心电描记术 超声心动图 心血管造影术 

分 类 号：R542.2[医药卫生—心血管疾病]