心尖肥厚型心肌病患者的临床及心电图特点  

The clinical and electrocardiographic characteristics of patients with apical hyperotrophic cardiomyopathy

作　　者：张剑[1] 赵英[1] 邹晶晶[1] 胡慧民[1] 李耀辉[1] 张文华[1] 张丹[1] 张闯[1] 张园[1] 韩雅玲[1] 

机构地区：[1]沈阳军区总医院全军心血管病研究所心内科,沈阳110840

出　　处：《心电图杂志（电子版）》2015年第2期88-90,共3页Journal of Electrocardiogram（Electronic Edition）

摘　　要：目的分析左室造影诊断的心尖肥厚心肌病(AHCM)患者的临床和心电图特征,探讨其临床和心电图特点。方法回顾性分析我中心2008年1月至2015年4月左室造影诊断的连续AHCM患者159例,入院后行常规实验室生化检查及临床辅助检查,并行冠脉造影及左室造影检查,排除合并冠心病患者。AHCM诊断标准为左室造影显示左室心尖部收缩期呈"黑桃"征。结果男性101例(63.5%),女性58例(36.5%),平均年龄为55.3±10.4岁。平均体重指数25.6±3.0、甘油三酯1.83±1.50 mmol/L,略高于一般正常值,合并高血压、糖尿病的比例分别为48.4%和8.2%。心电轴左偏占48.4%,左胸导联R波振幅异常增高(最高>2.5 m V)占90.6%,RV4>RV5>RV6比例70.4%,左胸导联ST段下移比例98.7%,所有患者均出现左胸导联T波深倒置,TV4>TV5>TV3比例达71.1%。超声心动图显示心尖部心肌明显增厚,平均达23.8±7.5 mm;心尖部心肌厚度与室间隔中部厚度之比达1.96±0.45;心尖四腔切面观察左室心尖部心腔收缩期闭塞,舒张末期呈"铲形"。左室造影显示心尖部心肌明显增厚,平均达24.6±8.3 mm,左室心尖部收缩期均呈"黑桃"征。结论 AHCM患者的心电图具有典型的特征性改变,对早期诊断具有一定的辅助诊断价值。Objective To analyze the clinical and electrocardiographic characteristics of patients with apical hyperotrophic cardiomyopathy（AHCM）, and assess those diagnostic value.Method The clinical and electrocardiographic data of 159 patients with AHCM were analyzed retrospectively from January 2008 to April 2015 .Results The history of AHCM was not typical,but its electrocardiogram had characteristic changes. The electrocardiogram in AHCM typically showed high voltage of left ventricles （The ratio of patients with maximum R wave amplitude 〉2.5mV was 90.6%）, the ratio of TV4〉TV5〉TV3 was 71.1%, ST-segment depression was 98.7%, and all patients had giant （〉10 mm） and inverted T waves in the precordial leads （particularly in leads V3-V5, the ratio of TV4〉TV5〉TV3 was 71.1%）. All cases had apical wall thickening in echocardiogram （mean value was 24.6±8.3mm）.All cases had a“spade-like” configuration on left ventriculogram.Conclusion Electrocardiogram played an important role in diagnosis of AHCM. Early electrocardiogram examination can enhance the diagnostic rate of patients with cardiomyopathy.

关 键 词：心尖肥厚心肌病 心电图 超声电动图 

分 类 号：R542.2[医药卫生—心血管疾病]