目的 探讨心电图、MRI及心脏 超声在诊断心尖肥厚型心肌病中的应用 价值。方法 回顾性分析2015年2月-2017 年10月本院收治的52例心尖肥厚型心肌 病患者的临床资料，均行心电图、MRI 及心脏超声检查，分析心尖肥厚型心肌 病患者影像学表现，并评估三种影像学 手段诊断心尖肥厚型心肌病的效能。结 果 52例病例患者心电图均有异常，左 胸导联RV4-6电压增高、左胸导联前后 肢对称且有深倒置巨大T波、ST段水平 压低各35(67.31%)、40(76.92%)、32例 (61.54%)，均无异常Q波，不同程度心 律失常6例(11.54%)；MRI影像学表现： 单纯型P-心尖部心肌肥厚、单纯型T-心 尖部心肌肥厚、混合型P-心尖部心肌肥 厚、混合型T-心尖部心肌肥厚各23、 12、12、5例；T-心尖部心肌肥厚患者 心尖部室壁弥漫性肥厚，以典型“黑桃 心”征象为主要表现，P-心尖部心肌肥 厚患者心尖部室壁轻度肥厚，多为节段 性肥厚，无“黑桃样”征象；超声检查 影像学表现以心尖部心肌对称或不对称 性肥厚为主，肥厚心肌回声不均匀，收 缩较僵硬，心尖部心腔狭小甚至闭塞， 超声检查22例未见明显异常，18例心尖 部心肌肥厚，8例左室舒张功能降低，10 例左房增大。结论 心电图、MRI及心脏 超声在诊断心尖肥厚型心肌病中均具有 一定价值，MRI可精确显示各心肌壁肥 厚程度，利于心肌病分型、心脏功能分 析，因而在心尖肥厚型心肌病诊断中较 心电图和超声更具优势。

Objective To investigate the value of electrocardiogram (ECG), MRI and cardiac ultrasound in the diagnosis of apical hypertrophic cardiomyopathy (AHCM). Methods The clinical data of 52 patients with AHCM who were admitted to the hospital from February 2015 to October 2017 were analyzed retrospectively. All patients underwent ECG, MRI and cardiac ultrasound examination. The imaging findings of AHCM were analyzed, and the effectiveness of three imaging methods in diagnosing AHCM was evaluated. Results There were 52 cases with abnormal ECG, 35 cases (67.31%) with increased left precordial RV4-6 voltage, 40 cases (76.92%) with giant negative T wave in ECG of left chest, 32 cases (61.54%) with low ST segment, no abnormal Q wave and 6 cases (11.54%) with different degrees of arrhythmia. MRI findings included simple P-apical hypertrophy, simple T-apical hypertrophy, mixed P-apical hypertrophy and mixed T- apical hypertrophy in 23 cases, 12 cases, 12 cases and 5 cases, respectively. There was apical wall diffuse hypertrophy in patients with T-apical hypertrophy, with typical black heart signs as main manifestations. There was apical wall mild hypertrophy in patients with P-apical hypertrophy, multi-segmental hypertrophy, without black heart signs. Ultrasound imaging findings mainly showed apical symmetric or asymmetric hypertrophy, uneven echo of myocardial hypertrophy, stiff contraction and narrow heart cavity or occlusion of the apex. Ultrasound examination showed that there were 22 cases without obvious abnormalities, 18 cases with apical hypertrophy, 8 cases with decreased left ventricular diastolic function and 10 cases with left atrial enlargement. Conclusion ECG, MRI and cardiac ultrasound are of certain value in the diagnosis of AHCM. MRI can accurately display the degree of myocardial wall hypertrophy, which is conductive to typing of cardiomyopathy and analyzing cardiac function. Therefore, MRI has more advantages over ECG and cardiac ultrasound in the diagnosis of AHCM.