Pinamonti B, Alberti E, Cigalotto A, Dreas L, Salvi A, Silvestri F, Camerini F
Divisione di Cardiologia, Università degli Studi, Trieste, Italy.
Am J Cardiol. 1988 Aug 1;62(4):285-91. doi: 10.1016/0002-9149(88)90226-3.
This study analyzes morphologic and functional alterations detected by M-mode and 2-dimensional echocardiography in 41 patients with histologically proven myocarditis and different clinical presentations: congestive heart failure (63%), atrioventricular block (17%), chest pain (15%) and supraventricular arrhythmias (5%). Left ventricular dysfunction was common (69%), particularly in patients with congestive heart failure (88%), often without or with minor cavity dilatation. Patients with atrioventricular block or chest pain had usually preserved ventricular function. Right ventricular dysfunction was present in 23%. Additional findings included asynergic ventricular areas (64%), left ventricular "hypertrophy" sometimes reversible (20%), hyperrefractile myocardial areas (23%), ventricular thrombi (15%) and "restrictive" ventricular filling (7%). It is concluded that echocardiographic features of myocarditis are polymorphous and nonspecific. The echocardiographic pattern can simulate alternatively dilated, hypertrophic, restrictive or "right" ventricular cardiomyopathy, as well as coronary artery disease. In an appropriate clinical context, echocardiography can be helpful in the diagnosis of myocarditis and in the selection of patients for endomyocardial biopsy.
本研究分析了41例经组织学证实为心肌炎且临床表现各异的患者，通过M型和二维超声心动图检测到的形态学和功能改变：充血性心力衰竭（63%）、房室传导阻滞（17%）、胸痛（15%）和室上性心律失常（5%）。左心室功能障碍很常见（69%），尤其是充血性心力衰竭患者（88%），常无或仅有轻微的心室扩张。房室传导阻滞或胸痛患者的心室功能通常保留。右心室功能障碍占23%。其他发现包括心室运动不协调区域（64%）、左心室“肥厚”（有时可逆，20%）、心肌高反射区域（23%）、心室血栓（15%）和“限制性”心室充盈（7%）。结论是，心肌炎的超声心动图特征是多形性且非特异性的。超声心动图表现可交替模拟扩张型、肥厚型、限制型或“右”心室心肌病，以及冠状动脉疾病。在适当的临床背景下，超声心动图有助于心肌炎的诊断以及心内膜心肌活检患者的选择。
