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致心律失常性左室心肌病

[Arrhythmogenic left ventricular cardiomyopathy].

作者信息

Havránek Štěpán, Paleček Tomáš, Kuchynka Petr, Vítková Ivana

出版信息

Vnitr Lek. 2016 Fall;62(9):728-735.

Abstract

Arrhythmogenic left ventricular cardiomyopathy (ALVC) is a rare condition characterised by progressive fibrofatty replacement of the myocardium of the left ventricle in combination with arrhythmias of left ventricular origin. ALVC has been linked to autosomal dominant mutations of genes encoding desmosomal proteins, similarly to the classic arrhythmogenic right ventricular cardiomyopathy with which it also shares pathological and prognostic features. It seems that isolated left or right ventricular abnormalities represent two extremes of the spectrum of clinical manifestations of a single disease: arrhythmogenic cardiomyopathy. In addition to arrhythmias originating from the left ventricle, the diagnosis of ALVC is based on identification of morphological changes of the left ventricle including late gadolinium enhancement with subepicardial to midwall distribution, corresponding to fibrous or fibrofatty replacement on histopathology. The diagnosis is confirmed by detection of a causal mutation. ALVC should be kept in mind in the differential diagnosis of ventricular tachycardia of non-ischemic origin.Key words: arrhythmogenic cardiomyopathy - cardiac magnetic resonance - late gadolinium enhancement - ventricular tachycardia.

摘要

致心律失常性左室心肌病(ALVC)是一种罕见疾病,其特征为左心室心肌进行性纤维脂肪替代,并伴有左室起源的心律失常。与经典的致心律失常性右室心肌病一样,ALVC与编码桥粒蛋白的基因常染色体显性突变有关,二者在病理和预后特征方面也有相似之处。孤立的左室或右室异常似乎代表了单一疾病——致心律失常性心肌病临床表现谱的两个极端。除左室起源的心律失常外,ALVC的诊断还基于左心室形态学改变的识别,包括钆延迟强化呈心外膜下至中层心肌分布,这与组织病理学上的纤维或纤维脂肪替代相对应。通过检测致病突变来确诊。在非缺血性室性心动过速的鉴别诊断中应考虑到ALVC。关键词:致心律失常性心肌病;心脏磁共振;钆延迟强化;室性心动过速

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