Furuki Maky, Kawai Hiroya, Onishi Tetsuari, Hirata Kenichi
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Kobe J Med Sci. 2009 Jun 5;55(1):E16-29.
Several studies have demonstrated that the natural course of hypertrophic cardiomyopathy can be variable, often unpredictable with high morbidity and mortality. Therefore, screening for potential cases and periodical evaluation of affected patients is compelling. The purpose of our study is to assess a relationship of the electrocardiographic finding of ST-segment elevation and/or abnormal Q waves with the development of left ventricular enlargement and wall motion abnormalities in the echocardiography and to propose these findings as a sign of left ventricular remodeling in patients with hypertrophic cardiomyopathy. We enrolled 110 patients with hypertrophic cardiomyopathy. Standard echocardiography and 12-lead electrocardiograms were analyzed. After initial evaluation, follow up was conducted with a mean interval of 20.3 months. In the electrocardiograms we found ST-segment elevation in 43.6% and abnormal Q waves in 18.1%; and left ventricular enlargement in 12.7% and wall motion abnormalities in 21.8% in the echocardiograms. Three different patterns of ST-segment elevation were acknowledged: concave (13.6 %), straight (16.3 %) and convex (13.6%). There was a close relationship between the electrocardiographic finding of convex ST-segment elevation and/or abnormal Q waves and the occurrence of left ventricular enlargement and/or wall motion abnormalities in the echocardiograms with a sensitivity of 62% and a specificity of 85%. However, the straight and concave-type ST-segment elevation showed a less significant relationship with the echocardiographic findings. This study suggested that the electrocardiographic finding of convex ST-segment elevation and abnormal Q waves could be valuable for detection of disease progression in patients with hypertrophic cardiomyopathy.
多项研究表明，肥厚型心肌病的自然病程可能各不相同，通常不可预测，发病率和死亡率都很高。因此，筛查潜在病例并对受影响患者进行定期评估势在必行。我们研究的目的是评估心电图上ST段抬高和/或异常Q波的表现与超声心动图中左心室扩大及室壁运动异常发展之间的关系，并提出将这些表现作为肥厚型心肌病患者左心室重构的一个标志。我们纳入了110例肥厚型心肌病患者。对标准超声心动图和12导联心电图进行了分析。初始评估后，进行随访，平均间隔时间为20.3个月。在心电图中，我们发现ST段抬高的比例为43.6%，异常Q波的比例为18.1%；在超声心动图中，左心室扩大的比例为12.7%，室壁运动异常的比例为21.8%。确认了ST段抬高的三种不同形态：凹面型（13.6%）、直线型（16.3%）和凸面型（13.6%）。心电图上凸面型ST段抬高和/或异常Q波的表现与超声心动图中左心室扩大和/或室壁运动异常的发生之间存在密切关系，敏感性为62%，特异性为85%。然而，直线型和凹面型ST段抬高与超声心动图表现的关系不太显著。这项研究表明，心电图上凸面型ST段抬高和异常Q波的表现对于检测肥厚型心肌病患者的疾病进展可能具有重要价值。
