Leitman Marina, Tyomkin Vladimir, Sternik Leonid, Copel Laurian, Goitein Orly, Vered Zvi
Sackler School of Medicine, Tel Aviv University, Zerifin, Israel.
Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel.
Echocardiography. 2018 Feb;35(2):260-266. doi: 10.1111/echo.13796. Epub 2018 Jan 9.
Until recently, diagnosis of intramyocardial dissecting hematoma (IDH) was performed during necropsy or at surgery. During the recent years, echocardiography has permitted clinical suspicion, which usually needed confirmation with magnetic resonance imaging (MRI). In this study, we tried to define clinical and imaging features of IDH and predictors of mortality. We searched the literature for proven cases of IDH and analyzed them together with 2 of our cases. A total of 40 cases of IDH (2 our original and 38 literature cases) were included. Mean age was 60. In 32 cases, IDH was a complication of myocardial infarction (MI), in 66% anterior, a mean time from symptoms to diagnosis was 9 days. Thirty-eight % underwent surgery. In-hospital mortality was 23%. Multivariate analysis showed that the strongest independent predictor of mortality (42%) was EF < 35%; in patients with age >60, mortality risk was 44%; and in the presence of MI or late diagnosis (>24 hours since symptoms started), mortality risk was 50%. In summary, IDH is a diagnostic challenge. A high level of suspicion is needed for prompt diagnosis. Management of these patients is based on individual clinical and imaging parameters. Low EF, age > 60, and late diagnosis, all are predictors of in-hospital mortality.
直到最近，心肌内夹层血肿（IDH）的诊断还只能在尸检或手术时进行。近年来，超声心动图已能引发临床怀疑，通常还需要磁共振成像（MRI）来确诊。在本研究中，我们试图明确IDH的临床和影像学特征以及死亡率的预测因素。我们在文献中搜索已证实的IDH病例，并将其与我们的2例病例一起进行分析。总共纳入了40例IDH病例（2例为我们最初的病例，38例为文献病例）。平均年龄为60岁。在32例中，IDH是心肌梗死（MI）的并发症，其中66%发生在前壁心肌梗死，从症状出现到诊断的平均时间为9天。38%的患者接受了手术。住院死亡率为23%。多变量分析显示，死亡率（42%）最强的独立预测因素是左心室射血分数（EF）<35%；年龄>60岁的患者，死亡风险为44%；存在MI或诊断延迟（症状出现后>24小时）的患者，死亡风险为50%。总之，IDH是一项诊断挑战。需要高度怀疑才能及时诊断。这些患者的治疗基于个体临床和影像学参数。低EF、年龄>60岁以及诊断延迟，均是住院死亡率的预测因素。
