Fukuda N, Oki T, Sakai H, Asai M, Ohshima C, Kusaka Y, Tominaga T, Murao A, Niki T, Mori H
J Cardiogr. 1983 Jun;13(2):327-41.
Mode of the splitting of the second heart sound ( IIs ) and left ventricular systolic time intervals (STIs) in patients (pts) with hypertrophic cardiomyopathy were compared with those in hypertension (HT) with the global hypertrophy of the left ventricular wall. Forty-seven pts with hypertrophic cardiomyopathy [non-obstructive type (HCM, 30 pts), obstructive type (HOCM, 17 pts)] and 21 pts with HT were studied. The pts with HCM were classified as septal hypertrophic type (19 pts) and apical hypertrophic type (11 pts) on the basis of the echocardiographic findings. The pts with HOCM were classified as resting type (13 pts) and latent type (provoked by amyl nitrite: 4 pts) on the basis of the obstructive sign at rest. Mode of the splitting of the IIs : a) The pts with HCM showed a wide splitting of the IIs . The mean split interval during held expiration (IIA-IIP) was 41.0 +/- 9.9 msec. Twenty pts (67%) showed abnormal respiratory splitting. The mean IIA-IIP interval in septal hypertrophic type (45.3 +/- 9.0 msec) was significantly wider than that in apical hypertrophic type (33.6 +/- 6.7 msec) (p less than 0.05). There was a positive correlation between IIA-IIP interval and the thickness of the upper portion of the interventricular septum (r = 0.63). b) Nine out of 13 pts with resting type of HOCM showed a paradoxical (reversed) splitting with a mean IIA-IIP interval of -23.8 +/- 24.4 msec. On the other hand, pts with latent type showed a wide splitting similar to HCM with a mean IIA-IIP interval of 35.0 +/- 7.1 msec. c) The pts with HT showed a single IIs or physiological splitting. The mean IIA-IIP interval was 14.5 +/- 9.3 msec, which was significantly decreased than that of normals or the pts with HCM (p less than 0.01). Left ventricular systolic time intervals: a) The pts with an either type of HCM showed a short corrected left ventricular electromechanical systole [(Q-IIA)c] due to the shortening of the corrected left ventricular ejection time (LVETc). b) The pts with resting type of HOCM showed a long (Q-IIA)c due to the prolongation of LVETc, but latent type showed the same change as in HCM. c) The pts with HT showed a tendency of prolongation of (Q-IIA)c due to slightly short LVETc and long corrected pre-ejection period (PEPc). Fractional shortening of the left ventricle (%FS) and mean velocity of circumferential fiber shortening (mean VCF) calculated from echocardiograms were significantly greater in both types of HCM than those in normals and HT (p less than 0.05). Left ventricular end-diastolic dimension was significantly decreased in the pts with septal hypertrophic type of HCM than in others.(ABSTRACT TRUNCATED AT 400 WORDS)
将肥厚型心肌病患者（pts）第二心音（IIs）的分裂模式和左心室收缩时间间期（STIs）与左心室壁整体肥厚的高血压（HT）患者进行比较。研究了47例肥厚型心肌病患者[非梗阻型（HCM，30例）、梗阻型（HOCM，17例）]和21例高血压患者。根据超声心动图结果，HCM患者分为室间隔肥厚型（19例）和心尖肥厚型（11例）。根据静息时的梗阻征象，HOCM患者分为静息型（13例）和隐匿型（亚硝酸异戊酯诱发：4例）。IIs的分裂模式：a）HCM患者表现为IIs宽分裂。屏气呼气时的平均分裂间期（IIA-IIP）为41.0±9.9毫秒。20例（67%）表现为异常呼吸分裂。室间隔肥厚型的平均IIA-IIP间期（45.3±9.0毫秒）显著宽于心尖肥厚型（33.6±6.7毫秒）（p<0.05）。IIA-IIP间期与室间隔上部厚度呈正相关（r = 0.63）。b）13例静息型HOCM患者中有9例表现为反常（逆向）分裂，平均IIA-IIP间期为-23.8±24.4毫秒。另一方面，隐匿型患者表现出与HCM相似的宽分裂，平均IIA-IIP间期为35.0±7.1毫秒。c）高血压患者表现为单一IIs或生理性分裂。平均IIA-IIP间期为14.5±9.3毫秒，显著低于正常人和HCM患者（p<0.01）。左心室收缩时间间期：a）任何一种类型的HCM患者由于校正后的左心室射血时间（LVETc）缩短，表现为校正后的左心室机电收缩期[（Q-IIA）c]缩短。b）静息型HOCM患者由于LVETc延长，表现为（Q-IIA）c延长，但隐匿型表现与HCM相同。c）高血压患者由于LVETc略短和校正后的射血前期（PEPc）延长，表现出（Q-IIA）c延长的趋势。根据超声心动图计算的左心室短轴缩短率（%FS）和圆周纤维平均缩短速度（平均VCF）在两种类型的HCM中均显著高于正常人和高血压患者（p<0.05）。室间隔肥厚型HCM患者的左心室舒张末期内径显著小于其他患者。（摘要截断于400字）
