CAJ | 학술논문

　　目的分析左室腔中部梗阻（MVO）的超声心动图特点，探讨超声心动图诊断MVO及其病因的临床价值。方法对73例左室腔中部血流速度≥2.5m/s（最大压差≥25mm Hg）患者资料进行分析。结果（1）25例肥厚型心肌病（HCM）与48例非HCM患者左室腔中部均测及特征性收缩中期失落呈刀锋状频谱图，左室中部平均流速3.11 m/s。（2）HCM组与非HCM组比，室间隔厚度（19.12±7.27）mm与（11.63±2.07）mm，差异有统计学意义（P<0.01）；左房大小（42.16±5.70）mm与（39.14±5.95）mm，差异有统计学意义（P=0.04）；左室腔中部流速（3.08±0.74）m/s与（3.09±0.70）m/s，差异无统计学意义（P=0.97）；非HCM组心室率（92.12±20.96）次/min，显著快于HCM组的（74.04±8.56）次/min，差异有统计学意义（P=0.01）；非HCM组出现低血压及使用去甲肾上腺素、多巴胺者明显多于HCM组。（3）分析非HCM致MVO原因，高血压25例，S形室间隔4例，其他血流动力学不稳定19例。结论超声心动图对诊断MVO具有重要价值。高血压心脏病、血流动力学不稳定、交感过度激活及正性肌力药是非HCM致MVO的主要原因。
　　목적분석좌실강중부경조（MVO）적초성심동도특점，탐토초성심동도진단MVO급기병인적림상개치。방법대73례좌실강중부혈류속도≥2.5m/s（최대압차≥25mm Hg）환자자료진행분석。결과（1）25례비후형심기병（HCM）여48례비HCM환자좌실강중부균측급특정성수축중기실락정도봉상빈보도，좌실중부평균류속3.11 m/s。（2）HCM조여비HCM조비，실간격후도（19.12±7.27）mm여（11.63±2.07）mm，차이유통계학의의（P<0.01）；좌방대소（42.16±5.70）mm여（39.14±5.95）mm，차이유통계학의의（P=0.04）；좌실강중부류속（3.08±0.74）m/s여（3.09±0.70）m/s，차이무통계학의의（P=0.97）；비HCM조심실솔（92.12±20.96）차/min，현저쾌우HCM조적（74.04±8.56）차/min，차이유통계학의의（P=0.01）；비HCM조출현저혈압급사용거갑신상선소、다파알자명현다우HCM조。（3）분석비HCM치MVO원인，고혈압25례，S형실간격4례，기타혈류동역학불은정19례。결론초성심동도대진단MVO구유중요개치。고혈압심장병、혈류동역학불은정、교감과도격활급정성기력약시비HCM치MVO적주요원인。
Objectives We investigated echocardiographic characteristics,pathogeny,and clinical values of midventricular obstruction(MVO). Methods The study population included 73 patients. MVO was diagnosed when the peak midcavitary gradient was estimated to be≧25mm Hg. Results MVO was identified in 25 patients with hypertrophic cardiomyopathy(HCM)and 48 with non-HCM. Peak systolic velocity obtained by continuous-wave Doppler averaged 3.11 m/s and appeared as either a "late-peaking"or a "spike and dome" configuration. No significant difference were found at MVO(3.08±0.74 VS 3.09±0.70,P=0.97),and significant difference were found at heart rate(74.04±8.56 VS 92.12±20.96,P=0.01),interventricular septum thickness (19.12±7.27 vs 11.63±2.07,P≤0.01)and left atriaum dimension(42.16±5.70 vs 39.14±5.95,=0.04)between HCM and non-HCM. In non-HCM patients,25 were hypertension,4 had sigmoid left ventricular septum,19 had unstable hemodynamics. Conclusions Echocardiography plays an important role for diagnosing MVO. Hypertension,unstable hemodynamics,excessive sympathetic activation,and inotropic agents are the main causes for MVO.