超声心动图鉴别诊断扩张型心肌病和缺血型心肌病

目的探讨超声心动图(UCG)对扩张型心肌病(DCM)和缺血型心肌病(ICM)的诊断与鉴别诊断价值。方法对经冠状动脉造影及临床证实的35例DCM和47例ICM的UCG表现进行回顾性分析比较。结果心脏增大,左室容量增加,心功能减低,二、三尖瓣关闭不全,肺动脉高压等发生率及严重程度DCM组明显重于ICM组(P<0.001)。DCM左室增大短径超过长径的1/2,呈“球形”改变,心尖部不变薄,室壁厚度均匀,运动弥漫性减弱。ICM左室心尖圆钝变薄且运动明显减弱,呈“圆拱门形”改变,室壁厚度不均并呈节段性运动异常,主动脉内径增宽,颈动脉内-中膜增厚为主要声像图特征。结论UCG具有形态学诊断和血流动力判断意义,对DCM和ICM的诊断与鉴别具有重要价值。

Differential Diagnosis of Dilated Cardiomyopathy and Ischemic Cardiomyopathy on Ultrasonic Cardiogram

Objective to investigate the diagnostic and differential diagnostic value of ultrasonic cardiogram(UCG) in patients with dilated cardiomyopathy(DCM) or ischemic cardiomyopathy(ICM).Methods UCG features of 35 cases with DCM and 47 cases with ICM were reviewed retrospectively.All the cases were confirmed by coronary angiography and clinically.Results The incidence and severe degrees of cardiac dilatation,left ventricular volume expansion,cardiac insufficiency,mitral/tricuspid incompetence,pulmonary hypertension etc were apparently higher in DCM than in ICM (P<0.001).In the DCM group,the left ventricular short axis were more than 1/2 longer than that of the long axis approaching to a spheroid type of LV,but the apex was thin without changing and the whole LV wall thinkness was uniform with globally universe weak activity.In ICM group,the left ventricular apex became thinner,weaker activity and an arc shaped or arcuate line shaped with abnormal segmental movements.The aortic diameter was increased;the carotid intima-media thickness(IMT) was increased with atherosclerotic plaque formation.Conclusions UCG has the advantage of morphological and hemodynamic judgement for diagnosis and defferential diagnosis between DCM and ICM.