摘要
目的随着心脏磁共振和心脏CT成像技术的广泛应用,肥厚型心肌病(HCM)肥厚部位与心电图的关系的研究逐渐深入.本研究通过精准分析HCM不同肥厚部位的心电图特征,初步探讨不同类型的HCM心电图诊断流程.方法 2013年9月至2017年9月收集大连医科大学附属第一医院69例均行心脏双源CT检查且临床确诊为HCM且不合并其他心血管或者非心血管疾病的患者,根据肥厚部位将其分为单纯心尖型(仅心尖肥厚)、心尖混合型(心尖合并室间隔或其他部位肥厚)、单纯室间隔型(仅室间隔肥厚)和室间隔混合型(室间隔合并除心尖外肥厚)4组,比较4组心电图特点.其中前2组定义为心尖肥厚组,后2组定义为非心尖肥厚组.采用多个构成比比较的卡方检验分析心电图的差异.结果①心尖肥厚组(单纯心尖型和心尖混合型)易出现倒置T波(100.0%,83.3%,35.7%,50.0%,P<0.05)或巨大倒置T波(44.4%,38.9%,0,0,P<0.05).其中倒置T波易出现在l、aVL导联和V3~V6导联,以TV4为轴心;巨大倒置T波易出现在V3~V5导联,以TV4为轴心;同一导联可见直立的R波,以RV4为轴心.②心尖混合型易出现左心室高电压(44.4%,72.2%,21.4%,28.6%,P<0.05).③非单纯心尖型易出现QRS波切迹(0,38.9%,57.1%,39.2%,P<0.05).其中QRS波切迹常见于Ⅲ、aVF导联.而单纯心尖型没有发现QRS波切迹.④单纯室间隔型易出现校正的QT间期(QTc)间期延长(44.4%,27.8%,50.0%,35.7%,P<0.05),平均QTc间期最长(470.9±39.9) ms.⑤室间隔混合型易出现深而不宽的病理性Q波(0,11.1%,7.1%,46.4%,P<0.05),常见于Ⅰ、aVL、Ⅲ、aVF导联和V5、V6导联.结论 HCM出现单纯左胸前导联T波倒置可能提示心尖部HCM;合并有左心室高电压和下壁导联的QRS波切迹,可能提示心尖混合型.如果没有上述特征,QTc间期延长可能提示单纯室间隔型;如果合并左胸前导联、侧壁导联或者下壁导联深而不宽的病理性Q波,可能提示室间隔混合型.不同肥厚部位HCM的心电图各有特征,是预测HCM类型的有力手段,对于临床建立不同类型的HCM心电图诊断流程有很大的帮助.
Objective The electrocardiographic features of different hypertrophic distribution were analyzed to establish the electrocardiogram diagnostic procedure of different types of hypertrophic cardiomyopathy (HCM).Methods Sixty-nine patients with HCM were divided into four groups:Group Ⅰ(only Apex),Group Ⅱ(Apex+Base),Group Ⅲ(only Base),Group Ⅳ(Base+noApex).Electrocardiographic parameters were assessed by chi-square test.Results ①T wave inversions (100.0%6,83.3%,35.7%,50.0%,respectively,P<0.01),and giant negative T wave (44.4%,38.9%,0,0,respectively,P<0.05) were more common in Group Ⅰ and Ⅱ.The T-wave inversions were commonly revealed in lead Ⅰ and aVL,lead V3 to V6.The giant negative T wave were commonly in lead V3 to V5.②Left ventricular high voltage (44.4%,72.2%,21.4%,28.6%,respectively,P<0.05) was more common in Group Ⅱ.③Non-simple apex type was prone to QRS notch (0,38.9%,57.1%,39.2%,respectively,P<0.05),and notched QRS was common in lead Ⅲ and aVF.④Asymmetric septal hypertrophic cardiomyopathy ASH paitents had more longer QTc interval (470.9±39.9) ms.Pathologic Q waves were more common in Group Ⅳ(44.4%,27.8%,50.0%,35.7%,respectively,P<0.05).⑤ Patients with interventricular septum were prone to deep and not wide pathological Q waves common in lead Ⅰ and aVL (30.8%),lead Ⅲ and aVF (46.2%),lead V5 and V6 (38.5%).Group had no pathologic Q waves.Conclusion SimpleTwave inversion in leftthoracic leads may indicate apical hypertrophic cardiomyopathy.QRS notches with left ventricular high voltage and notched QRS indicated apical mixed hypertrophy.The prolongation of QT interval may indicate simple septal type hypertrophy,deep and narrow pathologic Q waves in left precordial leads and inferior leads may indicate other sites hypertrophy combined with interseptum hypertrophy.
作者
苟成
曾星
许菲
邓明洁
秦茜
刘金秋
Gou Cheng;Zeng Xing;Xu Fei;Deng Mingjie;Qin Qian;Liu Jinqiu(1Department of Cardiology, The People’s Hospital Guang’an City,Guang’an 638000,China;Department ofCardiology, The first Affiliated Hospital o f Dalian Medical University, Dalian 116021, China)
出处
《中华心律失常学杂志》
2019年第4期324-329,共6页
Chinese Journal of Cardiac Arrhythmias
关键词
心电描记术
心肌病
肥厚型
肥厚部位
Electrocardiography
Cardiomyopathy,hypertrophic
Distribution of hypertrophy
作者简介
通信作者:刘金秋,Email:jinqiuliu@hotmail_com.
