左室肥厚的诊断及其鉴别诊断.pptx

左室肥厚的诊断及其鉴别诊断;目 录;心电图诊断;影像学诊断;左室后壁和室间隔厚度;LV mass：左室质量;LV mass index：左室质量指数;各项评估指标的参考值范围（UCG）;Relative wall thickness（RWT）相对壁厚度;Imaging in hypertensive heart disease Expert Rev Cardiovasc Ther. 2011,9(2): 199-209;左室肥厚的形态学分类;左室肥厚的形态学分类;二、左室肥厚的流行病学;Regional differences in the prevalence of left ventricular hypertrophy within Germany Eur J Cardiovasc Prev Rehabil 2009; 16:392–400;The study was a community-based cross-sectional study, and comprised 4270 hypertension patients withintegrated clinical and echocardiographic data. LVH was diagnosed by using the criteria of over 49.2 g/m2.7 for men and 46.7 g/m2.7 for women.LV mass was divided by height2.7 to obtain LV mass index (LVMIh2.7);高血压患者中左室肥厚的几何类型;三、左室肥厚的鉴别诊断;左室肥厚的鉴别诊断;不同致肥厚因素与左室肥厚几何类型及纤维化、细胞功能的关系;解剖学特点;组织学特点;常见左室疾病的临床特点;Br J Sports Med 2009 43: 649-656;左室肥厚的鉴别诊断—影像学进展;二维斑点追踪成像 two-dimensional speckle tracking imaging（STI）;斑点追踪技术（STI）-正常人;斑点追踪技术（STI）- 运动员心脏;斑点追踪技术（STI）-肥厚型心肌病;斑点追踪技术（STI）-心脏淀粉样变性;三维超声心动图计算MDI(mass dispersion index) Three Dimensional Echocardiography;Stefano Caselli, et al. Am J Cardiol 2008;102:616-620;J of Cardiovasc Trans Res. 2009; 2:415-425;-钆延迟显像 （LGE）在延迟钆增强序列心脏核磁成像时，钆停留在细胞外间隙扩大的心肌区域，呈亮信号影像(高度强化)。可用于检测肥厚型心肌病患者是否存在心肌纤维化或瘢痕。;中华心血管病杂志. 2009(37);12: 1057-1063;JACC. 2004; 12:2260–4;J Am Coll Cardiol 2008; 51:1022–30;各种检查手段 在左室肥厚识别及评估中的价值;心内膜心肌活检在心血管疾病鉴别诊断中的价值;四、左室肥厚的临床意义;高血压左室肥厚与全因死亡的关系—Framingham队列研究;N Engl J Med 1990;322:1561-6;274 subjects were followed for up to 8.7 years;Prognostic significance of electrocardiographic determined left ventricular hypertrophy and associated ST-segment depression in patients with non–ST-elevation acute coronary syndromes. Am Heart J 2011;161:878-85.;肥厚型心肌病基因诊断的价值不同表型的肥厚型心肌病的易感基因检出率不同;肥厚型心肌病致病基因携带与预后的关系;高血压基因筛查：没有一个肯定的易感基因 惠汝太教授: PGC1-α polymorphisms与高血压（不论有无心脏肥厚）无关，是HCM的修饰基因（增加肥厚）； 高血压肥厚与HCM的修饰基因不同。;2011 ACCF/AHA 肥厚型心肌病指南;谢 谢！