Zhao Y, Wang H, Yang K, Lin J R, Quan X, Qu R, Zhao S H
Department of Echocardiography Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beigjing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2023 Oct 24;51(10):1075-1079. doi: 10.3760/cma.j.cn112148-20230815-00079.
To explore the basic characteristics of conventional echocardiography of apical hypertrophic cardiomyopathy (ApHCM) patients complicating with left ventricular apical aneurysm (LVAA). This is a retrospective study. Patients who underwent echocardiography and cardiac magnetic resonance (CMR) and were diagnosed with ApHCM complicated with LVAA by CMR at Fuwai Hospital, Chinese Academy of Medical Sciences from August 2012 to July 2017 were enrolled. According to whether LVAA was detected by echocardiography, the enrolled patients were divided into two groups: LVAA detected by echocardiography group and LVAA not detected by echocardiography group. Clinical data of the two groups were compared to analyze the causes of missed diagnosis by echocardiography. A total of 21 patients were included, of whom 67.0% (14/21) were males, aged (56.1±16.5) years. Patients with chest discomfort accounted for 81.0% (17/21), palpitation 38.1% (8/21), syncope 14.3% (3/21). ECG showed that 21 (100%) patients had ST-T changes and 18 (85.7%) had deep T-wave invertion. Echocardiography revealed ApHCM in 17 cases (81.0%) and LVAA in 7 cases (33.3%). The mean left ventricular apical aneurysm diameter was 33.0 (18.0, 37.0) mm, and left ventricular ejection fraction was (66.5±6.6) %, and left ventricular apex thickness was (21.0±6.3) mm. Left ventricular outflow tract obstruction was presented in 4 cases and middle left ventricular obstruction in 10 cases. The mean left ventricular apical aneurysm diameter of LVAA detected by echocardiography was greater than that of LVAA not detected by echocardiography (25.0 (18.0, 28.0) mm vs. 16.0 (12.3, 21.0) mm, =0.006). Conventional echocardiography examination has certain limitations in the diagnosis of ApHCM. Smaller LVAA complicated with ApHCM is likely to be unrecognized by echocardiography. Clinicians should improve their understanding of this disease.
探讨肥厚型心肌病（ApHCM）合并左心室心尖部室壁瘤（LVAA）患者的常规超声心动图基本特征。本研究为回顾性研究。选取2012年8月至2017年7月在中国医学科学院阜外医院接受超声心动图及心脏磁共振成像（CMR）检查，并经CMR诊断为ApHCM合并LVAA的患者。根据超声心动图是否检测到LVAA，将入选患者分为两组：超声心动图检测到LVAA组和超声心动图未检测到LVAA组。比较两组患者的临床资料，分析超声心动图漏诊的原因。共纳入21例患者，其中男性占67.0%（14/21），年龄（56.1±16.5）岁。胸部不适患者占81.0%（17/21），心悸患者占38.1%（8/21），晕厥患者占14.3%（3/21）。心电图显示，21例（100%）患者有ST-T改变，18例（85.7%）有T波深倒置。超声心动图检查发现17例（81.0%）患者为ApHCM，7例（33.3%）患者有LVAA。左心室心尖部室壁瘤平均直径为33.0（18.0，37.0）mm，左心室射血分数为（66.5±6.6）%，左心室心尖部厚度为（21.0±6.3）mm。4例患者出现左心室流出道梗阻，10例患者出现左心室中部梗阻。超声心动图检测到LVAA患者的左心室心尖部室壁瘤平均直径大于未检测到LVAA患者（25.0（18.0，28.0）mm比16.0（12.3，21.0）mm，P=0.006）。常规超声心动图检查在ApHCM的诊断中存在一定局限性。ApHCM合并较小的LVAA可能无法被超声心动图识别。临床医生应提高对此病的认识。
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