De Piccoli B, Ciriello A, Trolese C, Franceschi M, Piccolo E
G Ital Cardiol. 1986 Apr;16(4):283-94.
39 patients affected with hypertrophic cardiomyopathy (ICM) have been studied by M-mode and two-dimensional echocardiography (1 and 2D Echo), standard electrocardiogram (ECG) and vectorcardiogram (VCG). For each patient we have outlined the anatomical shape of the left ventricle and we have tried to measure the myocardial hypertrophy by a score system that determines its size and extent. For this reason we have followed the echocardiographic segmental analysis procedure suggested by Edward (1981) but we have modified it dividing the left ventricle into 11 segments and measuring the value of the apex three times. We have given each patient a hypertrophy score by assigning a value 0 to any segment with a thickness less than or equal to 12 mm, a value 1 if the thickness was greater than 12 less than or equal to 17 mm, a value 2 if it was greater than 17 less than or equal to 22 mm, a value 3 if greater than 22 mm. We have also calculated the distribution index of the hypertrophy dividing the number of the hypertrophied segments by the number of the ventricular segments. We have identified five patterns of hypertrophic cardiomyopathy: 7 cases with a partial involvement of the interventricular septum (IVS) (pattern 1), 7 cases with a full involvement of the IVS (pattern 2), 22 cases with involvement of the free wall of the left ventricle (pattern 3), 2 cases with involvement of the distal IVS and the apex (pattern 4), 1 case with involvement of the inferior and lateral wall (pattern 5). The highest hypertrophy score and distribution index was noticed in the third anatomical pattern (p less than 0.001). Comparing the three more frequent anatomical patterns with their Ecg-Vcg aspects, we have found a higher prevalence of the left anterior hemiblock in pattern 1, of the pathological Q waves in pattern 2, of the left ventricular hypertrophy in pattern 3. However this correlation was not significant while the correlation between the Ecg-Vcg aspects and the myocardial hypertrophy score and distribution index was extremely significant (p less than 0.001). Consequently the size and distribution of the myocardial hypertrophy could differentiate the Ecg-Vcg aspects better than the anatomical shape of the left ventricle; when hypertrophy was moderate the left anterior hemiblock and the pathological Q waves were more frequent. On the contrary when hypertrophy was high and widespread the prevailing Ecg-Vcg aspect was the left ventricle hypertrophy.
对39例肥厚型心肌病（ICM）患者进行了M型和二维超声心动图（1D和2D Echo）、标准心电图（ECG）和向量心电图（VCG）检查。对于每位患者，我们勾勒出左心室的解剖形状，并试图通过一个确定其大小和范围的评分系统来测量心肌肥厚情况。因此，我们遵循了爱德华（1981年）建议的超声心动图节段分析程序，但对其进行了修改，将左心室分为11个节段，并对心尖值进行三次测量。我们为每位患者给出一个肥厚评分，对厚度小于或等于12mm的任何节段赋值0，厚度大于12mm小于或等于17mm赋值1，大于17mm小于或等于22mm赋值2，大于22mm赋值3。我们还通过将肥厚节段数除以心室节段数来计算肥厚分布指数。我们确定了肥厚型心肌病的五种模式：7例室间隔（IVS）部分受累（模式1），7例IVS完全受累（模式2），22例左心室游离壁受累（模式3），2例IVS远端和心尖受累（模式4），1例下壁和侧壁受累（模式5）。在第三种解剖模式中观察到最高的肥厚评分和分布指数（p小于0.001）。比较三种最常见的解剖模式与其心电图-向量心电图表现，我们发现在模式1中左前分支阻滞发生率较高，模式2中病理性Q波发生率较高，模式3中左心室肥厚发生率较高。然而，这种相关性并不显著，而心电图-向量心电图表现与心肌肥厚评分和分布指数之间的相关性极为显著（p小于0.001）。因此，心肌肥厚的大小和分布比左心室的解剖形状更能区分心电图-向量心电图表现；当肥厚为中度时，左前分支阻滞和病理性Q波更常见。相反，当肥厚程度高且广泛时，主要的心电图-向量心电图表现是左心室肥厚。
