超声心动图对左心室肌小梁增多伴发心内结构及功能改变的初步研究

摘要

目的 研究左心室肌小梁增多伴发的心内结构及功能改变,初步探讨其发生的可能因素.方法 筛选经胸超声心动图检查的左心室肌小梁增多成人患者,纳入其中在收缩末期胸骨旁左心室短轴切面观测量左心室非致密层心肌/致密层心肌(NC/C) ＞2者120例.测量左心室舒张末期前后径(LVEDD)和左心室射血分数(LVEF),二维结合彩色多普勒(CDFI)观察肌小梁间有无深陷隐窝.结合临床资料及其他检查对病因进行分类.结果 左心室肌小梁增多见于扩张型心肌病改变52例、心肌梗死13例、心瓣膜病28例、先天性心脏病12例以及无明确病因15例.其中,无明确病因组LVEDD、LVEF值与其他病因组比较,差异有统计学意义(P＜0.01).有14例可见深陷隐窝,分别见于扩张型心肌病改变5例、先天性心脏病1例、无明确病因8例.左室肌小梁增多合并隐窝(14例)与单纯肌小梁增多(106例)比较,LVEDD (54.5±8.2 vs 64.8±10.3)mm、LVEF (50.2±9.1 vs 41.6±8.7)％,差异均有统计学意义(P＜0.01).结论 左心室肌小梁增多见于多种病因,不仅仅是左心室心肌致密化不全的特征性改变,亦可能是慢性心力衰竭进展过程中左心室重构的一种继发性改变.%Objective To study the excessively prominent myocardial trabeculation of left ventricular combined with the changes of left ventricular structure and function,to preliminarily analyze the possible causes.Methods 120 adult patients with excessively prominent myocardial trabeculation of left ventricular,and the standard of end-systolic non-compacted layer/compacted layer(NC/C)ratio＞2 in the parasternal ventricular short-axis sectional view by transthoracic echocardiography were acceptable.Measured the left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF),to observe whether the deep inter-trabecular recesses were existed by two-dimension echocardiography and color Doppler flow image (CDFI).To classify of disease causes combined clinical data with auxiliary examination.Results The excessively prominent myocardial trabeculation of left ventricular happened in 52 cases of dilated cardiomyopathy(DCM),13 cases of myocardial infarction,28 cases of valvular disease,12 cases of congenital cardiopathy and 15 cases of no definite cause.The differences of LVEDD and LVEF between no definite cause group and others were statistically significant(P＜0.01).14 cases had the deep inter-trabecular recesses,5 cases of DCM,1 case of congenital cardiopathy and 8 cases of no definite cause,while compared with the simpler prominent trabeculations group,the LVEDD (54.5 ± 8.2 vs 64.8± 10.3) mm、LVEF (50.2 ± 9.1 vs 41.6 ± 8.7) ％,difference were statistically significant(P＜0.01).Conclusions The excessively prominent myocardial trabeculation of left ventricular might happen in many diseases,not only was a characteristic vary of LVNC but also a secondary left ventricular remodeling of chronic heart failure.