与超声心动图指征相关的左心室心肌小梁增多/致密化不全的心脏和神经学表现。

Cardiologic and neurologic findings in left ventricular hypertrabeculation/noncompaction relating to echocardiographic indication.

作者信息

Stöllberger Claudia, Winkler-Dworak Maria, Blazek Gerhard, Finsterer Josef

机构信息

2nd Medical Department, Krankenanstalt Rudolfstiftung, Juchgasse 25, A-1030 Wien, Austria.

出版信息

Int J Cardiol. 2007 Jun 25;119(1):28-32. doi: 10.1016/j.ijcard.2006.06.063. Epub 2006 Oct 4.

DOI:10.1016/j.ijcard.2006.06.063

PMID:17023079

Abstract

BACKGROUND

Left-ventricular hypertrabeculation/noncompaction (LVHT) is characterized by prominent trabeculations and intertrabecular recesses. LVHT is usually diagnosed if a patient is referred for echocardiography. The study assessed if cardiologic and neurologic findings differ relating to indication for echocardiography.

METHODS

Included were patients in whom LVHT was diagnosed in one echocardiographic laboratory between June 1995 and December 2005. All patients underwent a cardiologic examination and were invited for a neurological investigation.

RESULTS

LVHT was diagnosed in 93/35,181 patients (26 female, 53+/-15 years). Heart failure was the most frequent indication (n=49), followed by chest pain (n=21), syncope (n=8), search for cardiac involvement in myopathy (n=7), stroke or embolism (n=3), arterial hypertension (n=3) and screening of LVHT patients' relatives (n=2). Patients with the indication "heart failure" were older than patients with other indications (59.4+/-13.1 versus 44.9+/-12.9 years, p<0.001), had more often a neuromuscular disorder of unknown etiology (53% versus 32%, p<0.05), exertional dyspnoea (96% versus 32%, p<0.001), edema (25% versus 7%, p<0.05) and advanced heart failure (NYHA III: 41% versus 11%, p<0.01; NYHA IV: 29% versus 9%, p<0.05), suffered less often from arterial hypertension (22% versus 41%, p<0.05), angina pectoris (14% versus 34%, p<0.05) and palpitations or syncope (10% versus 30%, p<0.05). Patients with the indication "heart failure" had less frequent normal ECG than patients with other indications (2% versus 18%, p<0.01), had more frequent > or = 2 ECG abnormalities (57% versus 36%, p<0.05), left bundle branch block (29% versus 9%, p<0.05), a larger left-ventricular enddiastolic diameter (69.9+/-9.7 versus 57.4+/-12.2 mm, p<0.001), a lower left-ventricular fractional shortening (16.9+/-6.1% versus 31.1+/-11.5%, p<0.001) and more often valvular abnormalities (76% versus 30%, p<0.001). Location and extension of LVHT did not differ between indication groups.

CONCLUSION

Echocardiographers should be aware of LVHT in any indication for echocardiography.

摘要

背景

左心室致密化不全（LVHT）的特征是小梁和小梁间隐窝突出。通常在患者接受超声心动图检查时诊断出LVHT。本研究评估了因超声心动图检查指征不同，心脏和神经系统检查结果是否存在差异。

方法

纳入1995年6月至2005年12月期间在一个超声心动图实验室诊断为LVHT的患者。所有患者均接受了心脏检查，并被邀请进行神经学检查。

结果

在35181例患者中有93例诊断为LVHT（26例女性，年龄53±15岁）。心力衰竭是最常见的指征（n = 49），其次是胸痛（n = 21）、晕厥（n = 8）、寻找心肌病的心脏受累情况（n = 7）、中风或栓塞（n = 3）、动脉高血压（n = 3）以及对LVHT患者亲属的筛查（n = 2）。“心力衰竭”指征的患者比其他指征的患者年龄更大（59.4±13.1岁对44.9±12.9岁，p<0.001），更常患有病因不明的神经肌肉疾病（53%对32%，p<0.05）、劳力性呼吸困难（96%对32%，p<0.001）、水肿（25%对7%，p<0.05）和晚期心力衰竭（纽约心脏协会III级：41%对11%，p<0.01；纽约心脏协会IV级：29%对9%，p<0.05），较少患有动脉高血压（22%对41%，p<0.05）、心绞痛（14%对34%，p<0.05）以及心悸或晕厥（10%对30%，p<0.05）。“心力衰竭”指征的患者心电图正常的频率低于其他指征的患者（2%对18%，p<0.01），有≥2种心电图异常的频率更高（57%对36%，p<0.05）、左束支传导阻滞（29%对9%，p<0.05）、左心室舒张末期内径更大（69.9±9.7mm对57.4±12.2mm，p<0.001）、左心室短轴缩短率更低（16.9±6.1%对31.1±11.5%，p<0.001），并且更常出现瓣膜异常（76%对30%，p<0.001）。各指征组间LVHT的位置和范围无差异。