E0030318

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Not Applicable (or Unknown)

ダンソウ シンエコーホウ ニヨル ヒダイガタ シンキンショウ ノ ビョウタイ ニカンスル ケンキュウ トクニ シンデンズ ショケン トノ タイヒ

Clinical and pathophysiological study on hypertrophic cardiomyopathy in special reference to the comparison of echocardiogram and electrocardiogram

Japanese (日本語)

Medical journal of Kobe University

44(2)

145-156

1983-06

Hypertrophic patterns of the left ventricular wall (LVW) in patients with hypertrophic cardiomyopathy (HCM) were classified into four types using two-dimensional echocardiography and their relationship to clinical features were investigated. Subjects in this study consisted of 32 cases of obstructive type and 77 cases of non-obstructive type. Criteria of classification was as follows : Type I was hypertrophy limited to the interventricular septum (IVS), Type II was that of IVS and apex, Type III was hypertrophy of IVS, apex and posterior wall (PW) at the papillary muscle level, and Type IV was diffuse hypertrophy involving PW of more than 14mm. Hypertrophy of IVS is classified into 2 types by long-axis two dimensional echocardiograms. Type A was uniform hypertrophy of IVS from base to apex, type B was non-uniform hypertrophy of IVS which was dominant in the apical area. In order to indicate the location of the hypertrophied area of LVW in the short-axis view at the level of mitral chordae tendineae, a digital clock system was used. Twelve o'clock indicated the mid-anterior area of IVS and 6 o'clock the mid-posterior area of LVPW. Results obtained were as follows : 1) All of 32 cases with outflow tract obstruction were type III or IV, and 28 cases were A type (34% of A type). Moreover, 9 out of 10 cases without the maximal hypertrophy at 12 o'clock belonged to the non-obstructive type. Thus, hypertrophies in the papillary muscle, the LVPW at papillary muscle level and the anterior-upper portion of IVS were considered to cause the intraventricular pressure gradient of the LV. 2) When hypertrophy of IVS is maximum in the anterior-upper portion without remarkable hypertrophy in the apex and the LVPW, abnormal Q waves appeared in II, Ill, aV_F and left precordial leads, whereas in cases with the reversed distribution of hypertrophy, the abnormal Q waves appeared in I and aV_L leads. 3) Cases with high voltage of SV_1 + Rv_<50r6>, marked ST segment depression or T wave inversion belonged mainly to type II, III, or IV. These observations suggested that the hypertrophy of apex and LVPW caused the electrocardiographic changes of left ventricular hypertrophy.

electrocardiogram

紀要論文