Functional, morphological and electrocardiographical abnormalities in patients with apical hypertrophic cardiomyopathy and apical aneurysm: correlation with cardiac MR.
Functional, morphological and electrocardiographical abnormalities in patients with apical hypertrophic cardiomyopathy and apical aneurysm: correlation with cardiac MR.
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DOI：
10.1136/openhrt-2014-000124
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发表时间：
2014
期刊：
影响因子：
2.7
通讯作者：
Hayashi H
中科院分区：
文献类型：
--
作者：
Suwa K;Satoh H;Sano M;Nobuhara M;Saitoh T;Saotome M;Urushida T;Katoh H;Tawarahara K;Ohtani H;Wakabayashi Y;Takase H;Terada H;Takehara Y;Sakahara H;Hayashi H
心尖肥厚型心肌病（APH）的预后是良性的，但心尖心肌损伤具有预后重要性。我们研究了 APH 和心尖动脉瘤患者的功能、形态和心电图异常，并试图找到与心尖心肌损伤相关的参数。研究设计：多中心横断面研究。患者：滨松循环论坛数据库中经胸超声心动图 (TTE) 诊断的 45 例 APH 患者和 5 例心尖动脉瘤患者。测量：电影心脏 MR (CMR) 的心尖收缩、晚期钆增强 (LGE)-CMR 的心肌纤维化疤痕，以及当两个 ECG 导联表现出 RSR 模式时定义的 QRS 碎片 (fQRS)。 Cine-CMR 显示 27 名患者心尖收缩正常，12 名患者运动不足，11 名患者心尖收缩运动障碍。 TTE 将 11 名（48%）收缩功能减退和运动障碍的患者误诊为收缩正常的患者。心尖 LGE 在 10 名 (83%) 和 11 名 (100%) 收缩运动减退和运动障碍患者中明显，而仅 11 例 (41%) 收缩正常的患者 (p<0.01)。心尖收缩运动障碍患者的左心室射血分数最低，室性心动过速患病率最高，ST 压低和负 T 波深度最小。 fQRS 的存在与心尖收缩受损和心尖 LGE 相关（OR=8.32 和 8.61，p<0.05）。在分析 APH 和心尖动脉瘤患者的心尖异常方面，CMR 优于 TTE。 fQRS 的存在可能是早期检测心尖心肌损伤的一个有前景的参数。
The prognosis of apical hypertrophic cardiomyopathy (APH) has been benign, but apical myocardial injury has prognostic importance. We studied functional, morphological and electrocardiographical abnormalities in patients with APH and with apical aneurysm and sought to find parameters that relate to apical myocardial injury. Study design: a multicentre trans-sectional study. Patients: 45 patients with APH and 5 with apical aneurysm diagnosed with transthoracic echocardiography (TTE) in the database of Hamamatsu Circulation Forum. Measure: the apical contraction with cine-cardiac MR (CMR), the myocardial fibrotic scar with late gadolinium enhancement (LGE)-CMR, and QRS fragmentation (fQRS) defined when two ECG-leads exhibited RSR’s patterns. Cine-CMR revealed 27 patients with normal, 12 with hypokinetic and 11 with dyskinetic apical contraction. TTE misdiagnosed 11 (48%) patients with hypokinetic and dyskinetic contraction as those with normal contraction. Apical LGE was apparent in 10 (83%) and 11 (100%) patients with hypokinetic and dyskinetic contraction, whereas only in 11 patients (41%) with normal contraction (p<0.01). Patients with dyskinetic apical contraction had the lowest left ventricular ejection fraction, the highest prevalence of ventricular tachycardia, and the smallest ST depression and depth of negative T waves. The presence of fQRS was associated with impaired apical contraction and apical LGE (OR=8.32 and 8.61, p<0.05). CMR is superior to TTE for analysing abnormalities of the apex in patients with APH and with apical aneurysm. The presence of fQRS can be a promising parameter for the early detection of apical myocardial injury.