Horita Y, Genda A, Shimizu Y, Sugihara N, Suematsu T, Kita Y, Takeda R
Second Department of Internal Medicine, School of Medicine, Kanazawa University.
J Cardiol. 1988 Sep;18(3):651-64.
Fifteen patients, 12 males and three females, with hypertrophic cardiomyopathy (HCM) including three of obstructive type (HOCM) were investigated to observe the long-term course of HCM. Left ventriculography and bi-ventriculography were performed twice serially in all cases. We studied the correlations between the serial ECG changes, especially the negative T wave, and the left ventricular configuration, wall thickness, and left ventricular function. Serial ECG changes included: 1) negativity of the T wave which developed or increased concomitantly with increased voltages of SV1 + RV5 (A-1 group: five cases), 2) the negativity decreased or resolved with decreased voltages of SV1 + RV5 (A-2 group: four cases), and 3) insignificant changes of both T waves and SV1 + RV5 (B group: six cases). In the right oblique views at end-diastole, the configuration of the left ventricle was classified in three forms; (1) spade form (S), (2) round form (R), and (3) intermediate form (SR). The results were as follows: 1. The A-1 group showed increased thickness of the apical and anterior walls, but the thickness of the posterior wall and interventricular septal wall did not change serially. In three cases, the thickness of the interventricular septum showed mild hypertrophy at the initial and final observations. The configuration changed from the R or SR form to the S form. Diastolic dysfunction (peak dV/dt/V, peak dV/dt/EDV) was progressive, but end-diastolic volume and ejection fraction did not change. 2. The A-2 group showed the significantly decreased thickness of the apical and anterior walls. The thicknesses of the posterior wall and interventricular septal wall tended to decrease in all cases. In three cases (75%), the interventricular septal wall was markedly hypertrophied on the initial observation. The configuration changed from the S or SR form to the R form. Left ventricular diastolic function and ejection fraction decreased significantly and end-diastolic volume increased. Two cases showed clinical pictures of dilated cardiomyopathy at the final observation. 3. In the B group, there were no marked changes in wall thickness, left ventricular configuration, or systolic and diastolic functions. In conclusion, serial changes in left ventricular configuration, wall thickness, especially of the anterior and apical walls, and left ventricular function were all compatible with the serial changes of the ECG in hypertrophic cardiomyopathy.(ABSTRACT TRUNCATED AT 400 WORDS)
对15例肥厚型心肌病（HCM）患者进行了研究，其中男性12例，女性3例，包括3例梗阻型肥厚型心肌病（HOCM），以观察HCM的长期病程。所有病例均连续进行了两次左心室造影和双心室造影。我们研究了系列心电图变化，尤其是负向T波，与左心室形态、室壁厚度和左心室功能之间的相关性。系列心电图变化包括：1）T波倒置或加深，同时SV1 + RV5电压升高（A - 1组：5例）；2）随着SV1 + RV5电压降低，T波倒置减轻或消失（A - 2组：4例）；3）T波和SV1 + RV5均无明显变化（B组：6例）。在舒张末期的右前斜位片上，左心室形态分为三种类型：（1）铲形（S型）；（2）圆形（R型）；（3）中间型（SR型）。结果如下：1. A - 1组显示心尖部和前壁厚度增加，但后壁和室间隔厚度无系列变化。3例患者在初次和末次检查时室间隔厚度有轻度肥厚。形态从R型或SR型转变为S型。舒张功能障碍（峰值dV/dt/V、峰值dV/dt/EDV）呈进行性加重，但舒张末期容积和射血分数无变化。2. A - 2组显示心尖部和前壁厚度显著降低。所有病例的后壁和室间隔厚度均有降低趋势。3例（75%）患者在初次检查时室间隔明显肥厚。形态从S型或SR型转变为R型。左心室舒张功能和射血分数显著降低，舒张末期容积增加。2例患者出现扩张型心肌病的临床表现。3. B组室壁厚度、左心室形态以及收缩和舒张功能均无明显变化。总之，肥厚型心肌病患者左心室形态、室壁厚度（尤其是前壁和心尖部）以及左心室功能的系列变化均与心电图的系列变化相符。（摘要截断于400字）
