高血压所致左心室肥厚与肥厚型心肌病体表心电图和超声心动图的鉴别要点

马志玲; 赵志敬; 耶闯; 胡海霞; 刘丽文; 邵虹

doi:10.12125/j.chj.201807015

高血压所致左心室肥厚与肥厚型心肌病体表心电图和超声心动图的鉴别要点

Differentiation electrocardiogram and echocardiographic characteristics of hypertension induced left ventricular hypertrophy and hypertrophic cardiomyopathy

摘要

摘要:
目的比较高血压所致左心室肥厚与肥厚型心肌病（HCM）患者体表心电图及超声心动图参数之间的差异，探讨体表心电图对二者鉴别诊断的临床应用价值。
方法收集高血压致左心肥厚（H-LVH）患者，HCM患者及正常对照各49例。常规测量心电图中的P波时限、QTC时限，QRS波时限、异常q波数量、R波及S波振幅和ST-T与QRS波方向一致率，超声心动图中测量E/A、左室射血分数（LVEF）、室间隔厚度、左房内径（LA）、左心室收缩末期左右径（LVs左右径）、左心室舒张末期左右径（LVd左右径）、左心室收缩末期前后径（LVs前后径）、左心室舒张末期前后径（LVd前后径）、左心室收缩末期长轴（LVs长轴）、左心室舒张末期长轴（LVd长轴）等参数，比较3组之间的差异。
结果 HCM组患者与H-LVH组患者比较，最大左心室室壁厚度显著增厚，LVEF显著升高（均P<0.05），而HCM每博排出量（SV）、LVs左右径、LVd左右径、LVs前后径、LVd前后径、LVd长径显著小于H-LVH（均P<0.05）；心电图提示，HCM组患者II，III，Avf V1 V2导联R波与S波电压之和，QTC时限显著高于H-LVH组患者（P<0.01）；HCM患者异常Q波数量以及III、aVR导联ST-T与QRS波方向一致率显著高于H-LVH组（P<0.01）。
结论超声心动图可从左心室最大室壁厚度及肥厚特征鉴别HCM患者和H-LVH患者；体表心电图鉴别二者需结合QRS波振幅之和，QTC时限，II、V4导联异常Q波数量及导联ST-T与QRS波方向在V2、V3、V6导联的一致率4个参数。

Abstract:
AIM To compare the differences in parameters of 12 lead routine electrocardiogram (ECG) and echocardiography between patients with hypertrophic cardiomyopathy (HCM) and hypertension induced left ventricular hypertrophy (H-LVH). To evaluate the ECG in detecting patients with HCM and H-LVH.
METHODS Healthy individuals and patients with H-LVH or HCM were enrolled (n=49 in each group). ECG parameters were analyzed, including P wave duration, QTC duration, QRS duration, abnormal Q wave, the amplitude of R wave and S wave. E/A ratio, left ventricular ejective fraction (LVEF), maximum left ventricular wall thickness (MLVWT), left atrial diameter, systole of the left and right left ventricle, diastolic phase of the left and right left ventricle, systolic phase of the left ventricle anterior and posterior diameter, diastolic phase of the left ventricle anterior and posterior diameter, systole of the long axis of the left ventricle, diastolic phase of the long axis of the left ventricle were measured by conventional echocardiography. The above parameters were compared between groups.
RESULTS Compared with the H-LVH group, patients with HCM presented with increased LVEF and MLVWT (P < 0.05). However, Per stroke output, systole of the left and right left ventricle, diastolic phase of the left and right left ventricle, systolic phase of the left ventricle anterior and posterior diameter, diastolic phase of the left ventricle anterior and posterior diameter, systole of the long axis of the left ventricle, diastolic phase of the long axis of left ventricle of H-LVH group were significantly higher in patients with H-LVH than patients with HCM (P < 0.05).
CONCLUSION Compared with patients with H-LVH, patients with HCM had a higher QRS voltages in leads II, III, aVF, V1 and V2 and prolonged QTC duration(P < 0.01). The abnormal Q wave proportion and QRS main wave direction were consistent with T waves in lead III and aVR was higher in the HCM group.

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