Genda A, Taga K, Nakayama A, Nunoda S, Horita Y, Sugihara N, Takeda R
J Cardiogr. 1985 Jun;15(2):327-38.
To clarify the pathogenesis of apical hypertrophy with asymmetrical septal hypertrophy (ASH), left ventriculography in the right anterior oblique projection (LVG), biventriculography (BVG), and endomyocardial biopsy of the right ventricle were performed for patients with ASH. The patients were categorized in four groups according to ECG, LVG and BVG. Patients with hypertrophic cardiomyopathy (HCM) were divided into two subsets; (A) Apical hypertrophy group (AH: nine patients), with ECG showing left ventricular hypertrophy (LVH) and giant negative T waves (GNT), and with LV configurations showing the S or SR form at end-diastole on LVG. (B) Non-apical hypertrophy group (non-AH: 12 patients), with ECG showing LVH without GNT and LV configuration showing R form at end-diastole on LVG (cf: Fig. 1). Patients with ASH and hypertension (ASH-HT) were also divided into two subsets; (A) AH: seven patients. (B) non-AH: nine patients. Analysis of LVG and BVG: In HCM, the septal configuration showed the TS X S form in both two subset groups. The septal configuration in ASH-HT was divided into the NH form, which was clearly distinguishable from the septal configuration in HCM, and the TS X S form as in cases with HCM. In both HCM and ASH-HT, the diastolic thickness of the anterior apical wall was significantly thicker in all patients with AH than that in non AH. In HCM, the diastolic thickness of the septum and the percent systolic thickening did not significantly differ between AH and non-AH groups. In ASH-HT, the NH form showed similar diastolic thickness of the septum and % systolic thickening in AH and non-AH groups. On the other hand, the TS X S form in non-AH group showed greater thickness and lower % systolic thickening similar to those of HCM. Histological analysis of endomyocardial biopsy; In HCM, the transverse diameters of the myocytes and the biopsy scores did not differ significantly between AH and non-AH groups. In ASH-HT, the TS X S form in non-AH group had longer diameters and higher biopsy scores similar to those of HCM compared to the NH form in AH group. In conclusion, both HCM and ASH-HT may have apical hypertrophy manifested by giant negative T waves in the EKG and spade like form of left ventriculogram. In addition, apical hypertrophy in ASH-HT with the NH form of septal configuration seemed to be caused by hypertension.
为阐明伴有不对称性室间隔肥厚（ASH）的心尖肥厚的发病机制，对ASH患者进行了右前斜位左心室造影（LVG）、双心室造影（BVG）及右心室心内膜活检。根据心电图、LVG和BVG将患者分为四组。肥厚型心肌病（HCM）患者分为两个亚组：（A）心尖肥厚组（AH：9例），心电图显示左心室肥厚（LVH）及巨大倒置T波（GNT），LVG显示舒张末期LV形态呈S或SR型。（B）非心尖肥厚组（非AH：12例），心电图显示LVH但无GNT，LVG显示舒张末期LV形态呈R型（参见图1）。ASH合并高血压（ASH-HT）患者也分为两个亚组：（A）AH：7例。（B）非AH：9例。LVG和BVG分析：在HCM中，两个亚组的室间隔形态均呈TS X S型。ASH-HT的室间隔形态分为NH型（与HCM的室间隔形态明显不同）和与HCM病例相同的TS X S型。在HCM和ASH-HT中，所有AH患者舒张期心尖前壁厚度均显著厚于非AH患者。在HCM中，AH组和非AH组的室间隔舒张期厚度及收缩期增厚百分比无显著差异。在ASH-HT中，NH型在AH组和非AH组中室间隔舒张期厚度及收缩期增厚百分比相似。另一方面，非AH组的TS X S型与HCM相似，厚度更大且收缩期增厚百分比更低。心内膜活检组织学分析；在HCM中，AH组和非AH组的心肌细胞横径及活检评分无显著差异。在ASH-HT中，与AH组的NH型相比，非AH组的TS X S型直径更长且活检评分更高，与HCM相似。总之，HCM和ASH-HT均可有心尖肥厚，表现为心电图巨大倒置T波及左心室造影呈铲形。此外，ASH-HT中伴有NH型室间隔形态的心尖肥厚似乎由高血压引起。
