药物负荷超声心动图评价非肥厚型心肌病隐匿性室内梗阻的研究  

Drug stress echocardiography in the evaluation of latent intraventricular obstruction in non-hypertrophic cardiomyopathy

作　　者：郑南 罗定强 鲁亚玲 达姗姗 ZHENG Nan;LUO Ding-qiang;LU Ya-ling;DA Shan-shan(Department of Ultrasound Medicine,Sichuan Tianfu New Area People′s Hospital,Chengdu 610213,China)

机构地区：[1]四川天府新区人民医院超声医学科,四川成都610213

出　　处：《实用医院临床杂志》2022年第6期46-49,共4页Practical Journal of Clinical Medicine

基　　金：成都市卫健委医学科研课题项目(编号:2020168)。

摘　　要：目的 探讨药物负荷超声心动图在非肥厚型心肌病隐匿性左心室室内梗阻(LIVO)的诊断中的应用。方法 对591例临床疑诊晕厥伴胸骨左缘心脏收缩期杂音的非肥厚型心肌病患者进药物负荷超声心动图激发试验,对比分析隐匿性LIVO患者药物负荷超声心动图前后临床症状及超声心动图各参数变化。结果 591例药物负荷超声心动图患者中57例激发试验结果阳性,表现为隐匿性LIVO。其中,20例左室壁不对称性增厚(9例室间隔中部增厚),9例乳头肌肥大,5例二尖瓣副瓣或粗大瓣下腱索,4例左室腱索,3例心尖室壁瘤,14例混合因素。药物负荷后,隐匿性梗阻患者主动脉瓣口前向血流速度、狭窄处最大血流速度(LIVO-V)、狭窄处与主动脉瓣口流速比及狭窄处最大压力阶差(LIVO-PG)均较静息状态显著增加(P<0.05),并且出现8例Kissing征阳性(P<0.05),5例SAM征阳性(P>0.05),57例LIVO-V≥2.8 m/s, LIVO-PG≥30 mmHg。静息状态下LIVO-V均大于主动脉瓣口前向血流速度峰值,药物负荷超声心动图后该差值持续显著扩大,狭窄处与主动脉瓣口流速比≥1.8,压差比≥2.3;11例平时有症状的患者临床症状加重,16例新出现胸闷、气短、头痛等症状。结论 药物负荷超声心动图激发试验能够提高临床疑诊晕厥伴胸骨左缘心脏收缩期杂音的非肥厚型心肌病患者隐匿性LIVO的检出率,对预防晕厥、心源性猝死以及减少临床终点事件的发生等有重要的临床意义。Objective To explore the diagnostic value of the drug stress echocardiography(DSE) in non-hypertrophic cardiomyopathy(non-HCM) latent left intraventricular obstruction(LIVO).Methods Five hundred and ninety-one non-HCM patients with clinically suspected syncope and systolic murmur at the left sterna border were selected. The patients underwent DSE provocation test. The changes of clinical symptoms and parameters of echocardiography in these patients before and after DSE were compared and analyzed.Results Among the 591 patients with DSE, 57 were positive in provocation test, showing latent LIVO. Among the 57 patients, there were 20 with left ventricular asymmetric thickening(9 cases with thickened in the middle of ventricular septum), 9 with papillary hypertrophy, 5 with mitral valve accessory or thick subvalvular chordae tendineae, 4 with left ventricular chordae tendineae, 3 with apical ventricular aneurysm, and 14 with mixed factors. After DSE, AV(forward aortic valve blood flow velocity), LIVO-V(maximum blood flow velocity at the stenosis), ratio of stenosis to aortic valve orifice velocity, and LIVO-PG(maximum pressure gradient at the stenosis) in patients with latent LIVO were significantly higher than those in the resting state(P<0.05), and there were 8 cases of kissing sign positive(P<0.05), 5 cases of SAM sign positive(P>0.05). There 57 patients had LIVO-V ≥ 2.8 m/s, and LIVO-PG ≥ 30 mmHg. In the resting state, LIVO-V was higher than the peak value of forward blood flow velocity of aortic valve orifice, and the difference continued to increase significantly after DSE. The velocity ratio between stenosis and aortic valve orifice was ≥ 1.8 and the pressure difference ratio was ≥ 2.3. The clinical symptoms of 11 patients with usual symptoms were aggravated, and 16 patients had chest distress, shortness of breath, headache and other symptoms.Conclusions DES provocation test can improve the detection rate of latent LIVO in non-HCM with clinically suspected syncope and left stemal systolic murmur. It has

关 键 词：药物负荷超声心动图 非肥厚型心肌病 隐匿性左心室室内梗阻 

分 类 号：R542.2[医药卫生—心血管疾病] R445.1[医药卫生—内科学]