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目的 明确心脏无创性检查在儿童扩张型心肌病 (DCM )的变化及其在DCM与肥厚型心肌病 (HCM )、心内膜弹力纤维增生症 (EFE)鉴别中的价值。方法 对 14 6例DCM、4 1例HCM、5 9例EFE患儿 ,用心电图(EKG)、多普勒超声心动图 (ECHO)、彩色多普勒组织显像 (DTI)检查 ,并与 6 117名正常儿童EKG、2 86名正常儿童多普勒ECHO、14 3名正常儿童DTI检查对比。结果 EKG左室面电压增高者HCM、EFE显著多于DCM。多普勒ECHO检查 :DCM患儿心腔增大 ,左心室后壁 (LVPW )、室间隔 (IVS)不增厚 ;HCM患儿心腔不增大 ,LVPW、IVS增厚 ;EFE患儿心腔扩大 ,LVPW、IVS增厚。多普勒ECHO检查 :DCM和EFE患儿心脏收缩功能降低大于HCM患儿 ;DCM、HCM、EFE患儿心脏舒张功能下降差异无显著性。DTI检查 :HCM、DCM、EFE三者差异无显著性 ,DCM患儿心脏舒张功能降低重于收缩功能降低。DCM患儿MVRDeV <4cm/s者 ,预后极差。结论 EKG、多普勒ECHO、DTI对DCM的诊断和DCM与HCM、EFE的鉴别有重要价值。DTI对估计DCM预后有重要价值。
Objective To investigate the change of noninvasive cardiac examination in children with dilated cardiomyopathy (DCM) and its value in the differential diagnosis between DCM and hypertrophic cardiomyopathy (HCM) and endocardial fibroelastosis (EFE). Methods ECG, EKG, Doppler echocardiography and color Doppler echocardiography (DTI) were performed in 146 cases of DCM, 41 cases of HCM and 59 cases of EFE, and were compared with 6 117 normal children EKG, 2 86 normal children Doppler ECHO, 143 normal children DTI examination comparison. Results EKG left ventricular voltage increased HCM, EFE significantly more than DCM. Doppler ECHO examination: DCM patients with increased cardiac cavity, left ventricular posterior wall (LVPW), ventricular septal (IVS) is not thickening; HCM children did not increase the cardiac cavity, LVPW, IVS thickening; EFE heart Cavity expansion, LVPW, IVS thickening. Doppler ECHO examination: DCM and EFE children with systolic cardiac function decreased more than HCM children; DCM, HCM, EFE decreased diastolic function in children with no significant difference. DTI examination: HCM, DCM, EFE no significant difference between the three, DCM diastolic heart function decreased more than reduced contractile function. DCM patients with MVRDeV <4cm / s, the prognosis is poor. Conclusion EKG, Doppler ECHO, DTI diagnosis of DCM and DCM with HCM, EFE identification of great value. DTI is of great value in estimating the prognosis of DCM.