[经典]超声心动图对缺血性心肌病和扩张型心肌病的鉴别诊断

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1、[经典]超声心动图对缺血性心肌病和扩张型心肌病的鉴别诊断超声心动图对缺血性心肌病和扩张型心肌病的鉴別诊断【摘要】目的探讨超声心动图对缺血性心肌病(ICM)和扩张型心肌病(DCM)的鉴别诊断价值。方法对临床确诊的33例缺血性心肌病和29例扩张型心肌病进行超声心动图检查，比较两者在心脏形态学、血流动力学及心功能方面的差异。结果①ICM组心脏左房室腔扩大呈“圆拱门形”，心尖圆钝变薄，室壁活动呈节段性障碍；DCM组心脏多个房室腔扩大呈“球形”，室壁变薄而心尖部不变薄，室壁活动呈弥漫性减弱；②ICM组多为单瓣膜返流且程度较轻；DCM组多瓣

2、膜返流发生率高且程度较重；ICM组主动脉瓣返流高于DCM组(P<0.05)；③DCM组以收缩功能降低为主，舒张功能可表现为正常；ICM组以舒张功能障碍为主，收缩功能可表现为正常；二尖瓣E/A：ICM组〈1或〉2,而DCM组>l(P<0・05)。结论超声心动图是缺血性心肌病与扩张型心肌病鉴别的一种有价值的无创性手段。❷【关键词】超声心动图；扩张型心肌病；缺血性心肌病；鉴别诊断Thedifferentdiagnosisofechocardiographyforischemiccardiomyopathyanddilatedcardi

3、omyopathyLIUCui-hong,WANGLei,ZHAOKe-hui,etal.DepartmentofSpecialInspection,SecondAffiliatedHospital,ShandongMedicalUniversityofTCM,JinanCity,Shandong250001,China[Abstract]ObjectiveToinvestigatethedifferentdiagnosticvalueofechocardiographyforischemiccardiomyopathy(ICM

4、)anddilatedcardiomyopathy(DCM)・Methods33patientswithICMand29patientswithDCMreceivedechocardiography,Thefindingsincardiacmorphology,hemodynamicsandheartfunctionbetweenICMandDCMwascompared.Results①InICMgroupleftatrioventricularcavitywasdilated,theapexofleftventriclewas

5、thinspherical,theventricularwallmotiondecreasedsegmentally;inDCMgroupseveralatrioventricularcavitieswereglobalenlarged,normalcontractibleapexwasfounded,theventricularwa.11motiondecreaseddiffusely.②SlightregurgitationofsinglevalvewascommoninICM,butsevereregurgitationo

6、fmultiplevalveswasmorecommoninDCM;aorticregurgitationinICMgroupwaslargerthanthatinDCMgroup(P<0.05)•③InDCMgroupcardiacsystolicfunctionwasmostlydecreased,whereasdiastolicfunctionmaybenormal:inICMgroupdiastolicfunctionwasmarkedlydecreased,butsystolicfunctionmaybenormal;

7、E/Aofthemitralvalvewas2inICMgroup,butwas>linDCMgroup(P<0.05).ConclusionEchocardiographyisavaluablenoninvasivetechnologyfordifferentiatingICMandDCM.❷[Keywords]Echocardiography；Dilatedcardiomyopathy(DCM)；Iscemiccardiomyopathy(ICM)；Differentialdiagnosis令心肌病常导致心脏功能衰

8、竭而严重危害公众健康，早期诊断及早期治疗是降低其死亡率的关键。扩张性心肌病(DCM)和缺血性心肌病(ICM)是心肌病的两种常见类型，临床表现方面具有较多交叉重叠，缺乏特异性，而超声心动图是诊断心肌病首选的无创性检查手段，其临床应用日益广泛，因此，ICM与DCM的