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目的:探讨扩张型心肌病(DCM)中心室肌致密化不全(NVM)的识别及临床诊断。方法:收集2006-09-2010-09期间在我院初步诊断为DCM的住院患者共551例,根据患者病史、临床表现、辅助检查(彩色多普勒超声心动图、心电图、心脏磁共振等)、诊治过程以及随访结果等资料进行回顾性分析。结果:551例患者中,经超声心动图及心脏磁共振发现并确诊为NVM的患者34例,占DCM总数的6.17%,其检出率从2006年起呈逐年上升趋势。34例确诊为NVM的患者均表现有不同程度的心力衰竭;32例(94.12%)出现心电图异常;彩色超声心动图检测34例均可见NVM的典型改变(100%),其病变部位均累及左室;20例NVM患者平均随访(23±11)个月,4例死亡,主要死因为心力衰竭加重。结论:NVM患者以心力衰竭和心律失常为主要表现就诊,在DCM患者超声心动图检测时要注意识别DCM的病因之一———NVM,其检出率将会逐年上升。由于NVM预后不良,药物治疗只能缓解症状,心脏移植为终末阶段的治疗选择。
Objective: To investigate the identification and clinical diagnosis of ventricular myenteric degeneration (NVM) in dilated cardiomyopathy (DCM). Methods: A total of 551 hospitalized patients with DCM diagnosed in our hospital from September 2006 to September 2010 were collected. According to the patient’s medical history, clinical manifestations, auxiliary examinations (color Doppler echocardiography, electrocardiogram, cardiac magnetic resonance) , Diagnosis and treatment process and follow-up results and other data for retrospective analysis. Results: Of the 551 patients, 34 cases were found by echocardiography and cardiac magnetic resonance imaging and diagnosed as NVM, accounting for 6.17% of the total number of DCM. The detection rate showed an increasing trend from 2006 onwards. Thirty-four patients with NVM were diagnosed as having heart failure in varying degrees. Thirty-two patients (94.12%) had abnormal electrocardiogram (ECG). The typical changes of NVM were observed in 34 patients (100%) by color echocardiography. The average follow-up of 20 NVM patients was (23 ± 11) months. Four patients died. The main cause of death was heart failure. Conclusion: The NVM patients are mainly treated with heart failure and arrhythmia. In the echocardiographic examination of DCM patients, we should pay attention to identify one of the causes of DCM --- NVM, the detection rate will increase year by year. Due to the poor prognosis of NVM, drug treatment can only alleviate the symptoms, heart transplantation for the treatment of end-stage options.