Maron B J, Gottdiener J S, Bonow R O, Epstein S E
Circulation. 1981 Feb;63(2):409-18. doi: 10.1161/01.cir.63.2.409.
Twenty-one patients without evidence of hypertrophy by M-mode echocardiography were studied by wide-angle two-dimensional echocardiography to determine if they had a form of hypertrophic cardiomyopathy that could not be detected by conventional M-mode echocardiography. Each patient was suspected clinically of having hypertrophic cardiomyopathy because of a distinctly abnormal ECG and either a family history of hypertrophic cardiomyopathy or cardiac symptoms. Patients were 5-49 years old (mean 16 years) and 16 of the 21 had no functional limitation. The most common electrocardiographic abnormalities were deep Q waves, T-wave inversion and right ventricular hypertrophy. Using wide-angle two-dimensional echocardiography to reconstruct the geometry of the left ventricular wall, 16 of the 21 patients (76%) were shown to have prominent but unusually located regions of left ventricular wall hypertrophy. In each instance, the hypertrophy involved regions of the left ventricular wall through which the M-mode ultrasound beam does not usually pass, i.e., posterior ventricular septum (seven patients), anterior or lateral left ventricular free wall (seven patients) and ventricular septum near the apex (two patients). There was no echocardiographic or hemodynamic evidence of left ventricular outflow tract obstruction in any patient. Hence, some patients with hypertrophic cardiomyopathy may have substantial hypertrophy present in unusual locations of the left ventricular wall. Although electrocardiographic abnormalities suggested the presence of myocardial disease, conventional M-mode echocardiography (performed from standard parasternal positions) did not reliably identify such sites of hypertrophy, which were limited to regions of the left ventricle not accessible to the M-mode beam. Only wide-angle two-dimensional echocardiography permits definitive identification of these unusually located regions of cardiac hypertrophy and confirmation of the diagnosis of hypertrophic cardiomyopathy.
通过广角二维超声心动图对21例经M型超声心动图检查无肥厚证据的患者进行研究，以确定他们是否患有常规M型超声心动图无法检测到的肥厚型心肌病。由于心电图明显异常以及有肥厚型心肌病家族史或心脏症状，每位患者临床上均怀疑患有肥厚型心肌病。患者年龄在5 - 49岁之间（平均16岁），21例中有16例无功能受限。最常见的心电图异常为深Q波、T波倒置和右心室肥厚。利用广角二维超声心动图重建左心室壁的几何结构，21例患者中有16例（76%）显示左心室壁有明显但位置异常的肥厚区域。在每种情况下，肥厚累及M型超声束通常不经过的左心室壁区域，即室间隔后部（7例患者）、左心室前壁或侧壁（7例患者）以及心尖附近的室间隔（2例患者）。所有患者均无左心室流出道梗阻的超声心动图或血流动力学证据。因此，一些肥厚型心肌病患者可能在左心室壁的异常位置存在明显肥厚。尽管心电图异常提示存在心肌疾病，但常规M型超声心动图（从标准胸骨旁位置进行）不能可靠地识别这些肥厚部位，这些部位仅限于M型超声束无法到达的左心室区域。只有广角二维超声心动图能够明确识别这些心脏肥厚的异常位置，并确诊肥厚型心肌病。
