【摘要】 目的 对心尖肥厚型心肌病的辅助诊断进行探讨。方法 以心电图、超声心动图、放射核素心肌断层显像、冠状动脉造影及左室造影等检查方法，诊断28例心尖肥厚型心肌病。结果 28例心电图显示胸导联倒置的T波呈T_V4 >T_V5 的关系；超声心动图左室心尖部(乳头肌水平以下)心肌肥厚达12mm以上；18例行放射核素心肌断层显像见左心室心尖部心肌肥厚；20例左心室造影均提示心尖部心肌肥厚、冠脉造影正常，其中11例左心室舒张末期呈“黑桃”样改变。结论 标准12导联心电图显示胸导联倒置的T波伴R波振幅增高，而不伴有高血压病史者，应高度注意心尖肥厚型心肌病的诊断。

    Diagnosis of apical hypertrophic cardiomyopathy: A clinical report with 28 cases ZhouYingling, Li Yuhui, Chen Jiyan, et al. Guangdong Provincial Cardiovascular Institute,Guangzhou 510100

    【Abstract】 Objective The purpose of the study was to evaluate the value of ECGas compared with two-dimensional echocardiography for a reliable assessment of theclinical diagnosis of apical hypertrophic cardiomyopathy (AHCM).Methods and Results 28cases (22 males, 6 females, mean age 51.50±13.45 years) with AHCM were studied by ECG,echocardiography, radionuclide 99mTc-MIBI myocardial scanning, coronary angiography andleft ventriculography (LVG). ECG showed giant T wave inversion in chest leads. Theamplitudes of inverted T wave were in the pattern or T_V4 >T_V5 .Left ventricular wall thickness measured by echocardiography were≥12mm in apex in 28cases. Radionuclide myocardial scanning suggested apical hypertrophy in 18 cases. LVGdemonstrated apical hypertrophic cardiomyopathy with normal coronary angiogram in 20cases, 11 of which had the apical “spade” changes. Conclusion The character ofinverted T waves of T_V4 >T_V5 in ECG is of major value on clinicaldiagnosis of those with AHCM.

     ......