目的 探讨心尖肥厚型心肌病 (AHCM)患者的MRI表现和心电图的影像学 特点。方法 对我院心血管内科确诊的18 例AHCM患者(男12例，女6例)的磁共振成 像(MRI)和心电图影像学资料进行整理分 析。结果 共18例患者心脏MRI提示心尖部 肥厚，典型心尖肥厚型心肌病(T-ANCM)共 10例，早期心尖肥厚型心肌病(P-ACHM)共 8例，5例T-ACHM患者具有“黑桃心”的典 型征象，4例T-AHCM患者延迟期增强扫描 提示阳性。3例P-AHCM患者延迟期增强扫 描提示阳性。T-ACHM和P-AHCM延迟期增强 阳性率比较，无统计学意义(χ2 =0.01，P ＞0.05)。18例患者心电图均为异常心电 图，18例(100.00%)均有T波倒置，其中9 例深度大于1.1mV为巨大倒置T波，13例胸 前导联R波出现振幅明显增高，振幅深度 范围在2.0mV至5.1mV之间，15例出现ST段 下移；振幅深度范围在0.05mV至0.43mV之 间时，ST段压低成V6＜V5＜V4。18例心电 轴均为正常，无异常Q波出现。结论 心电 图方便、快捷，适用于心尖肥厚型心肌病 患者的筛查，但需与冠心病心电图进行鉴 别，MRI具有较高的诊断价值，可清晰显 示心脏结构及心肌灌注情况。

Objective To investigate the imaging features of MRI findings and

electrocardiogram (ECG) in patients with apical hypertrophic cardiomyopathy (AHCM).

Methods Magnetic resonance imaging (MRI) and electrocardiographic imaging data of

18 AHCM patients (12 males and 6 females) diagnosed by Department of Cardiology

in our hospital were collected and analyzed. Results Cardiac MRI showed cardiac

apical hypertrophy in 18 patients, and there were 10 cases of typical apical hypertrophic

cardiomyopathy (T-ANCM) and 8 cases of pre-apical hypertrophic cardiomyopathy

(P-ACHM), and 5 cases of T-ACHM patients were with “ black peach heart ” typical

sign, and 4 cases of T-AHCM patients showed positive in enhanced scans in delay phase,

and 3 cases of P-AHCM patients showed positive in enhanced scans in delay phase. There

was no statistically significant difference in the positive rate of delayed-phase enhancement

between T-ACHM and P-AHCM (χ2

=0.01, P>0.05). Electrocardiograms in 18 patients

were all abnormal, and T wave inversion was found in 18 cases (100.00%). Among them,

9 cases with a depth greater than 1.1mV were with huge inverted T wave, and 13 cases

showed an increased amplitude in precordial leads R waves. The amplitude depth ranged

from 2.0mV to 5.1mV, and 15 cases showed ST segment shift. When the amplitude depth

ranged from 0.05mV to 0.43mV, the ST segment depression became V6<V5<V4. And

18 cases were with normal cardiac electric axis without abnormal Q waves. Conclusion

Electrocardiogram is convenient and quick for screening of patients with apical

hypertrophic cardiomyopathy, but it needs to be differentiated from electrocardiogram

of coronary heart disease. MRI has high diagnostic value and can clearly show cardiac

structure and myocardial perfusion.