[Analysis of conventional echocardiographic features in apical hypertrophic cardiomyopathy patients complicated with left ventricular apical aneurysm].

Objective: To explore the basic characteristics of conventional echocardiography of apical hypertrophic cardiomyopathy (ApHCM) patients complicating with left ventricular apical aneurysm (LVAA). Methods: This is a retrospective study. Patients who underwent echocardiography and cardiac magnetic resonance (CMR) and were diagnosed with ApHCM complicated with LVAA by CMR at Fuwai Hospital, Chinese Academy of Medical Sciences from August 2012 to July 2017 were enrolled. According to whether LVAA was detected by echocardiography, the enrolled patients were divided into two groups: LVAA detected by echocardiography group and LVAA not detected by echocardiography group. Clinical data of the two groups were compared to analyze the causes of missed diagnosis by echocardiography. Results: A total of 21 patients were included, of whom 67.0% (14/21) were males, aged (56.1±16.5) years. Patients with chest discomfort accounted for 81.0% (17/21), palpitation 38.1% (8/21), syncope 14.3% (3/21). ECG showed that 21 (100%) patients had ST-T changes and 18 (85.7%) had deep T-wave invertion. Echocardiography revealed ApHCM in 17 cases (81.0%) and LVAA in 7 cases (33.3%). The mean left ventricular apical aneurysm diameter was 33.0 (18.0, 37.0) mm, and left ventricular ejection fraction was (66.5±6.6) %, and left ventricular apex thickness was (21.0±6.3) mm. Left ventricular outflow tract obstruction was presented in 4 cases and middle left ventricular obstruction in 10 cases. The mean left ventricular apical aneurysm diameter of LVAA detected by echocardiography was greater than that of LVAA not detected by echocardiography (25.0 (18.0, 28.0) mm vs. 16.0 (12.3, 21.0) mm, P=0.006). Conclusions: Conventional echocardiography examination has certain limitations in the diagnosis of ApHCM. Smaller LVAA complicated with ApHCM is likely to be unrecognized by echocardiography. Clinicians should improve their understanding of this disease.目的： 探讨心尖肥厚型心肌病（ApHCM）伴左心室心尖部室壁瘤（LVAA）的常规超声心动图基本特征。 方法： 本研究为回顾性研究。入选2012年8月至2017年7月在中国医学科学院阜外医院同时接受超声心动图和心脏磁共振（CMR）检查且由CMR诊断为ApHCM合并LVAA的患者。根据超声心动图是否检查出LVAA将纳入患者分为超声检出LVAA组及超声未检出LVAA组，比较2组的临床资料以分析超声心动图漏诊原因。 结果： 共纳入21例患者，其中男性占67.0%（14/21），年龄（56.1±16.5）岁。有胸部不适症状者占81.0%（17/21），心悸占38.1%（8/21），晕厥占14.3%（3/21）；心电图表现方面，ST-T改变占100%（21/21），T波深倒置占85.7%（18/21）。超声心动图检查出17例（81.0%）ApHCM，7例（33.3%）ApHCM合并LVAA，瘤体平均直径为33.0（18.0，37.0）mm，左心室射血分数（66.5±6.6）%，左心室心尖部厚度（21.0±6.3）mm。其中4例存在左心室流出道梗阻，10例存在左心室中部梗阻。超声检出LVAA组的瘤体平均直径大于超声未检出LVAA组［25.0（18.0，28.0）mm比16.0（12.3，21.0）mm，P=0.006］。 结论： 常规超声心动图诊断ApHCM存在一定的局限性，当合并LVAA瘤体平均直径越小，超声心动图越易漏诊，临床医师应提高对该疾病的认识。.