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心尖肥厚型心肌病(apical hypertrophic cardiomyopathy, AHCM)是肥厚型心肌病的一种特殊类型,有研究[1]显示,AHCM老年病人心房颤动、脑卒中、慢性心力衰竭等心血管事件的发生率及死亡率均明显增高[1]。早期心尖肥厚型心肌病(pre-apical hypertrophic cardiomyopathy, PAHCM)病人常因临床症状不明显或较轻,极易被漏诊。因此,提高PAHCM的诊断率对临床及早预防心血管事件具有一定意义[2]。本研究分析32例PAHCM病人超声心动图及声学造影资料,并与健康志愿者作比较,总结PAHCM的超声特征,旨在提高本病的诊断准确率。现作报道。
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60例疑似肥厚型心肌病的病人经MRI检查,32例确诊为PAHCM。该60例受检者在单独使用常规超声心动图检查时,仅14例被诊断为PAHCM,以MRI为金标准,常规超声心动图的真阳性9例,假阳性5例,敏感性28.1%,特异性82.1%。该60例受检者在使用心脏声学造影检查时,32例被诊断出PAHCM,以MRI为金标准,假阳性为0,敏感性100%,特异性100%(见图 1)。PAHCM组心电图检查均出现为ST-T改变,主要表现为T波倒置、ST段水平型下移、左室高电压。2组在性别、年龄、身高和体质量方面差异均无统计学意义(P>0.05)(见表 1)。
分组 n 男 女 年龄/岁 身高/cm 体质量/kg 正常对照组 32 22 10 46.41±12.53 168.56±6.46 63.81±7.85 PAHCM组 32 21 11 48.25±11.47 168.77±6.33 65.62±8.15 t — 0.07* 0.61 0.13 0.91 P — >0.05 >0.05 >0.05 >0.05 *示χ2值 表 1 2组一般情况比较(x±s)
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与正常对照组比较,PAHCM组的AT/LVPWT、LAV、LVM指标均增高(P<0.05),AT明显增高(P<0.01),E/A比值明显下降(P<0.01);2组LVPWT、LVEF差异无统计学意义(P>0.05)(见表 2)。
分组 AT/mm LVPWT/mm AT/LVPWT LAV/mL LVM/g LVEF/% E/A 正常对照组 8.24±1.21 9.03±0.76 0.95±1.04 41.25±8.57 116.35±24.51 68.45±4.67 1.23±0.52 PAHCM组 12.45±1.87 9.12±0.85 1.55±1.15 45.76±9.06 131.01±21.31 66.79±6.32 0.69±0.41 t 10.69 0.45 2.18 2.07 2.55 1.20 4.61 P <0.01 >0.05 <0.05 <0.05 <0.05 >0.05 <0.01 表 2 2组心脏构型及心功能指标的比较(ni=32;x±s)
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与N-AM组比较,P-AM组A、β及A×β值均明显下降(P<0.01);与P-LVPW组比较,P-AM组A值下降(P<0.05),β及A×β值明显下降(P<0.01)(见图 2);与N-LVPW组比较,P-LVPW组的A、β及A×β值变化差异均无统计学意义(P>0.05)(见表 3)。
分组 n A/dB β/s A×β/(dB/s) P-AM组 92 6.86±1.74 0.81±0.43 5.89±2.64 N-AM组 160 7.50±1.65 1.18±0.49 8.17±3.11 t — 2.91 6.03 5.91 P — <0.01 <0.01 <0.01 P-LVPW组 64 7.48±1.59* 1.15±0.67** 7.93±2.69** N-LVPW组 64 7.51±1.71 1.17±0.36 8.15±2.92 t — 0.10 0.21 0.44 P — >0.05 >0.05 >0.05 与P-AM组比较*P<0.05,**P<0.01 表 3 2组心肌声学造影指标比较(x±s)
超声心动图结合声学造影对早期心尖肥厚型心肌病的诊断
Value of echocardiography combined with ultrasound contrast in the diagnosis of pre-apical hypertrophic cardiomyopathy
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摘要:
目的探讨超声心动图结合声学造影在早期心尖肥厚型心肌病(PAHCM)诊断中的应用。 方法选择磁共振成像确诊为PAHCM的病人32例,正常对照组为32名健康志愿者,对比2组间超声心动图及声学造影特征。 结果与正常对照组比较,PAHCM组左室心尖部与后壁心肌厚度比值、左室心肌重量、左房容积指标均增高(P < 0.05),左室心尖部心肌厚度明显增高(P < 0.01),E/A比值明显下降(P < 0.01);与正常对照组心尖部心肌比较,PAHCM组心尖肥厚心肌组(P-AM组)平台峰值强度(A)、曲线上升斜率(β)及A×β值均明显下降(P < 0.01);与PAHCM组左室后壁组(P-LVPW组)比较,P-AM组造影A值下降(P < 0.05~P < 0.01)、β值及A×β值明显下降(P < 0.01);与正常对照组的左室后壁比较,P-LVPW组的A、β及A×β值差异无统计学意义(P>0.05)。以磁共振诊断为金标准,常规超声心动图诊断PAHCM的敏感性和特异性为28.1%、82.1%,超声心动图结合声学造影的敏感性和特异性为100%、100%。 结论超声心动图结合声学造影在PAHCM的诊断中具有较高的临床应用价值。 Abstract:ObjectiveTo discuss the application value of echocardiography combined with ultrasound contrast in the diagnosis of pre-apical hypertrophy cardiomyopathy(PAHCM). MethodsThirty-two patients with PAHCM diagnosed by MRI and 32 healthy volunteers were divided into the PAHCM group and normal control group, respectively.The characteristics of echocardiography and ultrasound contrast were compared between two groups. ResultsCompared with normal control group, the ratio of the myocardial thickness of left ventricular apical to posterior wall, left ventricular mass and left atrial volume increased(P < 0.05), the left ventricular apical myocardial thickness increased significantly(P < 0.01), and the value of E/A decreased significantly in PAHCM group(P < 0.01).Compared with the posterior wall myocardium of left ventricle of PAHCM group(P-LVPW group), the level of peak strength of platform(A) decreased(P < 0.05 to P < 0.01), and the curve rise slope(β) and A×β decreased significantly in P-AM group(P < 0.01).The differences of the levels of A, β and A×β between P-LVPW group and posterior wall myocardium of left ventricle in normal control group were not statistically significant(P>0.05).Using the diagnosis of MRI as a golden standard, the sensitivity and specificity of conventional echocardiography in the diagnosis of PAHCM were 28.1% and 82.1%, respectively, and both the sensitivity and specificity of echocardiography combined with ultrasound contrast in the diagnosis of PAHCM were 100%. ConclusionsEchocardiography combined with ultrasound contrast has great clinical application value in the diagnosis of PAHCM. -
Key words:
- hypertrophic cardiomyopathy /
- echocardiography /
- contrast agent
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表 1 2组一般情况比较(x±s)
分组 n 男 女 年龄/岁 身高/cm 体质量/kg 正常对照组 32 22 10 46.41±12.53 168.56±6.46 63.81±7.85 PAHCM组 32 21 11 48.25±11.47 168.77±6.33 65.62±8.15 t — 0.07* 0.61 0.13 0.91 P — >0.05 >0.05 >0.05 >0.05 *示χ2值 表 2 2组心脏构型及心功能指标的比较(ni=32;x±s)
分组 AT/mm LVPWT/mm AT/LVPWT LAV/mL LVM/g LVEF/% E/A 正常对照组 8.24±1.21 9.03±0.76 0.95±1.04 41.25±8.57 116.35±24.51 68.45±4.67 1.23±0.52 PAHCM组 12.45±1.87 9.12±0.85 1.55±1.15 45.76±9.06 131.01±21.31 66.79±6.32 0.69±0.41 t 10.69 0.45 2.18 2.07 2.55 1.20 4.61 P <0.01 >0.05 <0.05 <0.05 <0.05 >0.05 <0.01 表 3 2组心肌声学造影指标比较(x±s)
分组 n A/dB β/s A×β/(dB/s) P-AM组 92 6.86±1.74 0.81±0.43 5.89±2.64 N-AM组 160 7.50±1.65 1.18±0.49 8.17±3.11 t — 2.91 6.03 5.91 P — <0.01 <0.01 <0.01 P-LVPW组 64 7.48±1.59* 1.15±0.67** 7.93±2.69** N-LVPW组 64 7.51±1.71 1.17±0.36 8.15±2.92 t — 0.10 0.21 0.44 P — >0.05 >0.05 >0.05 与P-AM组比较*P<0.05,**P<0.01 -
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