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目的心尖肥厚型心肌病(AHCM)症状不典型,部分患者常规检查阳性率低,易漏诊和误诊,本文拟对AHCM的临床特征,如心电图、超声心动图、左心室及冠状动脉造影等检查进行分析。方法30例住院患者,入院诊断为冠心病,其中男23例,女7例,年龄(52．5±13．4)岁。超声心动图检查:测量室隔厚度(IVS)、左室后壁厚度(LVPW)、左室舒张末内径(LVDd)、收缩末内径(LVDS)、左房前后径(LA)及左室EF值,同时探查心尖厚度,测量二尖瓣口的血流频谱,得出舒张早期峰值流速E峰,舒张晚期峰值流速A峰。左心室及冠状动脉造影:6 F猪尾导管送入左室,记录左室压力,行左室到升主动脉连续测压,并行左心室造影,多个投照体位行左右冠状动脉造影。结果30例患者中,19例为劳力性疼痛,11例为活动时有胸闷气喘症状。所有患者心电图均表现为V3一V5导联R波高大,T波深倒,表现为T V4>T V5> TV3倒置。6例心前导联ST V2-V5段呈水平状下移1-2 mm,1例STⅡ、Ⅲ、aVF水平下移2 mm。23例行二维超声心动图检查,证实有心尖部心肌肥厚,其中合并其他部位肥厚8例。左心室舒张末期内径(47．3±4．4)mm．收缩末期内径(28．5±4．9)mm;左心房(36．1±3．1)mm。E F为(58．2±17．7)％,室间隔厚度为(11．6±4．3)mm,左室后壁为(10．2±1．9)mm,心尖部厚15-27 mm,平均18．6 mm,左心室游离壁为11．6 m m。二尖瓣血流频谱,均表现为E／A<1。30例行左心室及冠状动脉造影,左心室测压显示左室舒张末压升高,平均左室舒张末压为(27．3±6)m m H g,左心室到主动脉连续测压左室流出道无压力阶差存在。4例冠状动脉造影显示冠状动脉有狭窄。其中1例患者冠状动脉狭窄>75％,给予PCI治疗。3例冠状动脉狭窄30％-50％,其余患者冠状动脉正常。结论由于AHCM病变部位主要局限在左室乳头肌以下心尖部,其心电图的表现常被误诊为冠心病心肌缺血,常规超声检查因视窗所限,易忽略该区域而造成漏诊。对于ECG有特殊表现,结合心脏超声,对于有明显心肌缺血证据者,应行左心室造影及冠状动脉造影。
Aim The present study was designed to evaluate the clinical features of AHCM such as electrocardiogram, echocardiography, left ventricular and coronary angiography, and so on. analysis. Methods Thirty hospitalized patients were admitted to hospital for diagnosis of coronary heart disease, including 23 males and 7 females, with an average age of (52.5 ± 13.4) years. Echocardiography: IVS, LVPW, LVDd, LVDS, LA and EF of the left ventricle , At the same time to explore the apical thickness, measurement of mitral valve blood flow spectrum, obtained peak early diastolic velocity E peak, peak diastolic peak A peak. Left ventricular and coronary angiography: 6 F pigtail catheter into the left ventricle, recording left ventricular pressure, line left ventricular ascending aorta continuous manometry, parallel left ventricular angiography, multiple shots position around the coronary angiography. Results Of the 30 patients, 19 were labor pain and 11 were chest tightness and asthma symptoms. ECG in all patients showed a high-R wave of V3 a V5 lead, T wave deep down, the performance of T V4> T V5> TV3 inversion. 6 cases of ST V2-V5 segments of the heart lead down 1-2 mm horizontal, 1 case of ST Ⅱ, Ⅲ, aVF level down 2 mm. 23 cases of two-dimensional echocardiography, confirmed cardiac apical hypertrophy, which combined with other parts of hypertrophy in 8 cases. Left ventricular end-diastolic diameter (47.3 ± 4.4) mm. End-systolic diameter (28.5 ± 4.9) mm; left atrium (36.1 ± 3.1) mm. EF was (58.2 ± 17.7)%, interventricular septum thickness was (11.6 ± 4.3) mm, left ventricular posterior wall was (10.2 ± 1.9) mm, apex thickness was 15-27 mm, an average of 18.6 mm, free wall of the left ventricle was 11.6 mm. Left ventricular diastolic pressure showed elevated left ventricular end-diastolic pressure, mean left ventricular end diastolic pressure was (27.3 ± 6) mm Hg, left ventricular to aortic continuous pressure left ventricular outflow tract pressure gradient exists. 4 cases of coronary angiography showed coronary artery stenosis. One of the patients had coronary stenosis> 75% and was given PCI. 3 cases of coronary stenosis 30% -50%, the remaining patients with normal coronary arteries. Conclusion Because of the limited localization of the AHCM lesion in the apex below the left ventricular papillary muscle, its electrocardiogram performance is often misdiagnosed as coronary heart disease. The conventional ultrasonography is limited by the window and may be overlooked in the region. For ECG has a special performance, combined with echocardiography, evidence of significant myocardial ischemia, left ventricular angiography and coronary angiography should be performed.