心尖肥厚型心肌病的心电图特征

目的探讨心尖肥厚型心肌病的心电图特点。方法对29例心尖肥厚型心肌病的常规12导联心电图进行分析。结果患者V3～V5导联R波电压增高、ST段压低，均表现为V4〉V5〉V3，T波对称性倒置，呈V4〉V5〉V6。V3～V6导联同导联R波高度与T波倒置深度、ST段压低深度呈负相关（P均〈0．05），T波倒置深度与ST段压低深度呈正相关（P〈均0．01）。结论常规心电图显示胸导联R波电压增高伴ST-T特征性改变，要高度考虑心尖肌肥厚性心肌病。     

心尖肥厚型心肌病的临床诊断探讨

目的 了解心尖肥厚型心肌病的临床表现和辅助检查特点。方法 总结２９例心尖肥厚型心肌病的临床表现和心电图,超声心动图,核素心肌断层显像,运动平板心电图及冠状动脉和左室造影的特征,确定心尖肥厚型心肌病的诊断方法。结果 心电图显示以胸导为主的导联Ｒ波振幅呈Ｖ４≥Ｖ５〉Ｖ３关系增高,同时伴有Ｔ波对称性深倒置,超声心动图和核素心肌断层显像显示心尖部肌肉肥厚,２０例活动平板心电图有心肌缺血,左心室造影心尖部肌     

胸导联心电图R-ST-T变化对心尖肥厚型心肌病的诊断价值

目的探讨胸导联心电图R-ST-T变化与心尖肥厚型心肌病(AHCM)的关系.方法对经超声心动图和/或左心室造影确诊的42例AHCM病人(AHCM组)及35例非AHCM病人(对照组)的心电图进行对比分析,分析胸导联心电图R-ST-T变化(R波增高呈RV4＞RV5＞RV3,T波倒置呈TV4＞TV5＞TV3,ST段下移,且均无动态演变)对判断AHCM的临床价值.结果 AHCM组心电图出现异常42例(100%).胸导联心电图R-ST-T变化在AHCM的出现率为78.6%,显著高于对照组的8.6%(P＜0.01).胸导联心电图R-ST-T变化预测AHCM的敏感度为78.6%、特异度为91.4%.5例AHCM病人胸导联心电图R-ST-T变化早于超声心动图及左心室造影改变.结论胸导联心电图R-ST-T变化是诊断AHCM的敏感、特异的预测指标,心电图对AHCM的诊断具有早期预测意义.     

心尖肥厚型心肌病与冠心病的心电图对比分析

目的 比较心尖肥厚型心肌病与冠心病患者的心电图特征,分析其心电图的异同.方法 随机抽取2009年3月-2012年3月我院收治的心尖肥厚型心肌病患者40例和同期的冠心病患者40例.分别对两组患者进行心电图检查,比较两组患者的心电图差异.结果 心尖肥厚型心肌病组的R波明显高于对照组,差异有统计学意义(P＜0.05);而两组间倒置T波、ST段压低比较,差异无统计学意义(P＞0.05).结论 心尖肥厚型心肌病患者早期易被误诊为冠心病,根据患者的心电图改变特征并结合临床症状进行综合分析,以提高病情诊断的准确率.     

心尖部肥厚型心肌病的影像学诊断特点

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.     

心尖肥厚型心肌病的心电图特点

心尖肥厚型心肌病的心电图表现类似冠心病,但经其他辅助检查不支持冠心病的诊断。现报道我院所见7例,旨在提高对本病的心电图认识。     

非典型心尖肥厚型心肌病的心电图及超声心动图表现

目的 :探讨 11例仅心电图异常 T波改变 ,而按冠心病诊治无效患者的病因 ,并评价其预后。　　方法 :对 11例非典型心尖肥厚型心肌病患者 (男 6例、女 5例 )进行心电图、核素心肌断层、踏车运动试验、2 4小时动态心电图、超声影像等检查 ,并与正常人配对比较。　　结果 :11例患者心尖室壁肥厚 ,其舒张期厚度 (平均 1.42± 0 .2 3 cm ) ,与心室间隔基底段舒张期厚度 (1.0 7± 0 .0 7cm )之比为 1.45± 0 .16 ,心尖肥厚组心尖室壁舒张期厚度与正常对照组 (1.0 3± 0 .11cm)比较其差异非常显著 (P<0 .0 1) ,各心腔大小、左心室后壁、左心室收缩及舒张功能正常 ;心电图除 T波异常外无其它异常表现 ,其他各项检查均正常。　　结论 :非典型心尖肥厚型心肌病患者 ,特别是早期病变无特异性临床表现时 ,易漏诊和误治 ,常规测量心尖室壁厚度可指导早期诊断和治疗。     

心尖肥厚型心肌病与典型肥厚型心肌病的临床特点比较

目的 通过与典型的肥厚型心肌病(HCM)比较,探讨中国汉族人心尖肥厚型心肌病(AHCM)的临床特征及其诊治方法.方法 回顾性收集160例HCM住院患者的临床资料,分成3组进行比较.AHCM组:AHCM 41例.典型HCM患者(室间隔以及左心室壁肥厚),根据是否存在流出道梗阻分成2组,即非梗阻性肥厚型心肌病(NOHCM)组,52例,左心室流出道压差＜30 mm Hg(1 mm Hg=0.133 kPa);梗阻性肥厚型心肌病(OHCM)组,67例,左心室流出道压差≥30mm Hg.比较3组患者的临床症状、诊治方法以及血浆生物标记物水平.结果 (1)AHCM组患者的发病年龄较OHCM组晚[(49.9±13.6)岁比(41.4±14.6)岁,P＜0.01],无猝死家族史,较少出现劳力性呼吸困难,血浆血N末端B型利钠肽原(NT-pro BNP)水平较OHCM组低(P＜0.01).血浆心肌酶中肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、肌钙蛋白I(TnI)和肌红蛋白(MYO)的水平在3组间差异均无统计学意义.(2)31例AHCM患者因冠心病收治入院,经检查后,18例(18/41,43.9%)排除了冠心病.(3)AHCM组、NOHCM组和OHCM组心电图上深尖倒置T波(GNT)出现的频率分别为43.9%、13.5%和4.4%(P＜0.01),且AHCM组多伴有左心室高电压.(4)心脏核磁共振诊断AHCM明显优于心脏超声,与诊断典型HCM相比更有优势.结论 AHCM与典型OHCM的临床特点比较差异有统计学意义,而与典型的NOHCM比较差异无统计学意义.心脏核磁共振检查阳性及心电图胸导联上典型的GNT可为确诊AHCM提供依据.

Abstract：

Objective To evaluate the clinical features in Chinese patients with apical hypertrophic cardiomyopathy (AHCM) and typical hypertrophic cardiomyopathy (HCM). Methods This retrospective analysis included 160 patients hospitalized in Fuwai hospital. Patients were divided into three groups: apical hypertrophic cardiomyopathy ( AHCM, n = 41 ) group, non-obstructive typical hypertrophic cardiomyopathy group[NOHCM, LVOT ＜30 mm Hg(1 mm Hg =0. 133 kPa) at rest, n =52] and obstructive typical hypertrophic cardiomyopathy (OHCM, LVOT ≥ 30 mm Hg at rest, n = 67). Clinical features, diagnosis,therapy, and plasma levels of biomarkers of these three groups were analyzed. Results ( 1 ) The age at disease onset was older in AHCM group than in OHCM group [(49. 9 + 13. 6) years vs. (41.4± 14. 6)years, P ＜ 0. 01]. Exertional dyspnea appered more often in HCM patients than in AHCM patients, NT-proBNP level was significantly lower in AHCM patients than in OHCM patients (P =0. 001 ). Plasma CK-MB, LDH, TnI and MYO levels were similar among the three groups. (2) Thirty-three AHCM patients were first hospitalized for suspected coronary heart disease (CHD) and CHD was excluded in 18 cases (43.9%).(3) The frequency of giant negative T waves (depth≥10 mm) on ECG was 43.9%, 13.5% and 4.4%(P ＜ 0. 01 ) in AHCM, NOHCM and OHCM respectively. Half of AHCM patients showed left ventricular high voltage on ECG. (4) Cardiac magnetic resonance imaging is superior to echocardiography on correctly diagnosing AHCM. Conclusion AHCM patients differ from typical OHCM patients in clinical characteristics. There were significant differences on echocardiography and electrocardiography features among three groups. Cardiac magnetic resonance imaging and giant negative T waves on ECG are helpful for the diagnosis of AHCM.     

心尖肥厚型心肌病心电图1例

患者男性 ,４０岁。因胸闷１年 ,加重３天入院。曾诊断为冠心病。体检 :ＢＰ１１０／７０ｍｍＨｇ,心界不大 ,心尖搏动强有力 ,心率６８次／ｍｉｎ ,心律齐 ,心尖区可闻及Ⅱ级收缩期杂音及第３心音。肝脾无肿大。Ｘ线胸片及血清心肌酶检查正常。心电图 (图１)示 :窦性心律 ,心率６０次／ｍｉｎ ,Ｐ＿Ｒ间期０．１４ｓ ,ＱＲＳ时间０．０８ｓ ,ＱＲＳ波群在Ⅱ导联呈Ｒ型 ,Ｖ５ 导联呈ＲＳ型 ,Ｖ６ 导联呈Ｒｓ型 ,没有Ｑ波 ,而Ｖ１、２ 导联呈ＱＳ型 ,没有ｒ波 ,Ｖ４～６ＳＴ段压低＞０．０５ｍＶ ,Ｔ波Ｉ、ａＶＬ浅倒 ,Ｖ３～６ 深尖倒置 ,Ｖ…     

心尖肥厚型心肌病的心电图对比观察

目的　观察心尖肥厚型心肌病 (AHCM )与其他类型的肥厚型心肌病 (HCM )的心电图改变。方法　对 87例HCM(B组 )者行彩色多普勒超声心动图 (UCG)及心电图检测 ,对比 1 6例AHCM组 (A组 )与 71例HCM组 (B组 )的心电图ST段压低、T波倒置、传导阻滞、病理性Q波、左室高电压、WPW的发生率。结果　A组与B组的病理性Q波、巨大倒置T波的发生率存在显著性差异 (P <0 0 5 )。结论　A、B组两组之间虽然心电图及其它方面存在许多共性 ,但病理性Q波以及巨大倒置T波的存在与否 ,对两种HCM的心电图改变有鉴别诊断价值。     

Electro‐ and echocardiographic features of left ventricle hypertrophy in patients with hypertrophic cardiomyopathy

BackgroundStandard 12‐lead electrocardiogram (ECG), next to medical history and physical examination, is a basic screening tool for hypertrophic cardiomyopathy in General practice. There are many electrocardiographic criteria of left ventricular hypertrophy, but their accuracy is usually weak in patients with systemic hypertension or aortic stenosis. Sensitivity of these criteria in patients with HCM has not been well described.AimTo assess the prevalence of electrocardiographic criteria for LVH in patients with HCM and their relationship with echocardiographic parameters.Material and methodsA total of 49 patients with HCM (mean age 53.2 ± 15.4 years; men/women: 31/18) were enrolled to study. Eight electrocardiographic criteria for LVH were evaluated and correlated with echocardiographic parameters.ResultsThe ECG features of LVH were found in 36 (73.5%) subjects. These patients had increased thickness of intraventricular septum (20.5 ± 4.7 vs. 17.3 ± 3.2 mm, p = .03), LVM (340.5 ± 104.8 vs. 264.0 ± 61.5 g; p = .02), and LVMI (178.9 ± 48.8 vs. 125.9 ± 22.5; p = .002). All of ECG criteria for LVH had low sensitivity (14.3%–40.8%) for LVH diagnosis confirmed by echocardiography. The most common positive criterion was Cornell Voltage (20 patients; 40.8%). A total of 41 (83.4%) patients had T‐wave inversion in limb and/or precordial leads. LVMI correlated positively with R‐wave amplitude in aVL (R = 0.34; p = .03), Gubner‐Ungerleider voltage (R = 0.4; p = .009), and Cornell Voltage (R = 0.31; p = .04).ConclusionECG criteria for LVH are characterized by poor sensitivity in patients with HCM. Cornell Voltage and criteria based on limb leads correlate positively with LVMI.     

肥厚性心肌病心尖肥厚亚型的临床诊断(附28例临床报告)

目的对心尖肥厚型心肌病的辅助诊断进行探讨。方法以心电图、超声心动图、放射核素心肌断层显像、冠状动脉造影及左室造影等检查方法，诊断２８例心尖肥厚型心肌病。结果２８例心电图显示胸导联倒置的Ｔ波呈ＴＶ４＞ＴＶ５的关系；超声心动图左室心尖部（乳头肌水平以下）心肌肥厚达１２ｍｍ以上；１８例行放射核素心肌断层显像见左心室心尖部心肌肥厚；２０例左心室造影均提示心尖部心肌肥厚、冠脉造影正常，其中１１例左心室舒张末期呈“黑桃”样改变。结论标准１２导联心电图显示胸导联倒置的Ｔ波伴Ｒ波振幅增高，而不伴有高血压病史者，应高度注意心尖肥厚型心肌病的诊断。     

肥厚型心肌病的心电图改变

目的 探讨肥厚型心肌病患者心电图变化及其临床意义。方法 对44例肥厚型心肌病(Ⅰ型前间隔肥大14例，Ⅱ型前间隔、后间隔均肥大18例，Ⅲ型左心室前壁或／和侧壁、后壁肥大7例，Ⅳ型心尖部肥大5例)行常规12导联心电图检查。结果 心电图异常(ST-T改变、异常Q波、心室肥大等)发生率为93．2％。Ⅳ型ST-T改变多见于前侧壁、高侧壁，具有特殊性。其它三型患者异常Q波、ST-T改变发生率及部位差异均无显著性意义。结论 肥厚型心肌病患者大多存在不同程度的心电图异常，但除心尖肥厚型心肌病外，其他各型心电图改变无特异性。     

Magnetic resonance imaging for assessment of apical hypertrophy in hypertrophic cardiomyopathy

The purpose of the study was to evaluate the value of magnetic resonance imaging as compared with two-dimensional echocardiography for a reliable assessment of the degree and distribution of apical hypertrophy in hypertrophic cardiomyopathy (HCM). The study includes 10 HCM patients (8 males and 2 females, mean age: 42±7 years). Two-dimensional echocardiography was not definitive in assessing the abnormal thickening of the apical myocardium in two patients. Two other patients had inadequate echocardiographic visualization of the lower left ventricle due to technical reasons. At magnetic resonance imaging, 3 patients showed localized hypertrophy at the left ventricular apex only. Three other patients had evidence of hypertrophy at the apex as well as at the left ventricular free wall. In four patients, the hypertrophy was detected at either the apex or the lower interventricular septum. It is concluded that magnetic resonance imaging might provide an accurate assessment of myocardial hypertrophy in HCM patients. This technique appears to be of major value in those with wall thickening localized to (or predominant in) the apical portion of the ventricle.     

Impaired coronary circulation in patients with apical hypertrophic cardiomyopathy: noninvasive analysis by transthoracic Doppler echocardiography

OBJECTIVES: We designed this study to examine the characteristics of coronary circulation in patients with apical hypertrophic cardiomyopathy (ApHCM) using noninvasive transthoracic Doppler echocardiography (TTDE). BACKGROUND: Recent advances in TTDE have allowed noninvasive assessment of coronary circulation by the measurement of coronary flow velocity (CFV) patterns and coronary flow velocity reserve (CFVR). However, there have been no previous studies evaluating coronary circulation in ApHCM. METHODS: We analyzed CFV and CFVR in the left anterior descending coronary artery (LAD), and apical wall thickness in the left ventricle, in 10 ApHCM subjects and 10 control subjects. Mean diastolic velocity (MDV) and time from the beginning of diastole to peak velocity (TPV), and CFVR, defined as a ratio of drug-induced hyperemic to basal MDV, were measured. RESULTS: At baseline, MDV was higher, and TPV was longer, in ApHCM subjects than in control subjects (29 +/- 5.7 versus 19 +/- 6.5 cm/sec; p < 0.01 and 5.2 +/- 1.0 versus 3.5 +/- 0.6 msec; p < 0.005, respectively). CFVR in ApHCM subjects was significantly lower than in control subjects (1.9 +/- 0.4 versus 3.1 +/- 0.8; p < 0.005). CFVR and basal MDV in ApHCM subjects showed significant correlations with apical/posterior wall thickness ratio [CFVR; r =-0.84, p < 0.01 and MDV; r = 0.74, p < 0.05, respectively]. CONCLUSION: Noninvasive coronary flow assessment by TTDE revealed an impaired coronary circulation with reduced CFVR, high MDV at baseline and prolonged TPV. These results suggest that these characteristics of coronary circulation may provide an additional index for the assessment of ApHCM.     

Systolic apical filling in a patient with progressive apical hypertrophic cardiomyopathy and giant negative T waves

A relatively asymptomatic 58-year-old nonhyper-tensive male developed changes of remarkable apical hypertrophic cardiomyopathy associated with deep negative T-wave change and marked ventricular dyssynergy without apparent precipitating cause over a nine-year period.     

心尖肥厚型心肌病53例临床分析

目的:探讨心尖肥厚型心肌病(AHCM)的临床表现、心电图特点、冠状动脉造影(CAG)结果和长期预后情况。方法:对53例经超声心动图确诊的AHCM患者,进行病史回顾、体格检查、心电图和CAG检查,并通过电话和门诊随访,了解心血管事件发生情况。结果:AHCM患者病史不典型,但心电图有特征性变化,表现为胸前导联巨大倒置T波,尤其以V4导联显著,伴有ST段下移,常被误诊为冠心病。30例行CAG者中28例示左冠状动脉明显增粗;3例发现器质性狭窄,并成功置入支架;7例发现心肌桥,均位于左前降支。经0·4~7·5年的随访,仅1例死于癌症。结论:AHCM有比较典型的心电图表现,左冠状动脉内径增粗,常并发肌桥和冠心病,远期预后较好。     

心尖肥厚型心肌病患者心电图的诊断意义

目的探讨心尖肥厚型心肌病患者的心电图特征性改变及临床诊断意义。方法分析38例心尖肥厚型心肌病患者的心电图及超声心动图资料。结果心尖肥厚型心肌病合并有心电图异常和超声心动图异常改变者38例(100%),其中伴胸前导联巨大倒置T波≥0.2mV～0.3mV,以V3～V4最明显29例(76%);左胸V4～V6导联R波电压增高,且RV4>RV5>RV6者26例(68.4%);ST段压低,以V3～V4最明显者29例(76%);超声心动图示心尖部肥厚达15mm或以上伴心尖部心腔狭小者38例。结论心电图对心尖肥厚型心肌病具有早期诊断价值和预测意义。     

心尖肥厚型心肌病的研究进展

心尖肥厚型心肌病(AHCM)是肥厚型心肌病(HCM)的一种较为罕见的表型,其肥厚部位主要限于左室心尖部,主要以V4~V6巨大倒置T波及左室造影呈“锹状”改变为特征。本文对该病发病情况、病因、病理、病理生理及诊治情况的最新进展作一综述。