medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-265medsovet-7809Research ArticleИНСТРУМЕНТАЛЬНЫЕ МЕТОДЫ ИССЛЕДОВАНИЯINSTRUMENTAL METHODS OF DIAGNOSISРоль эхокардиографии в ведении пациентов с гипертрофической кардиомиопатией (обзор литературы)The role of echocardiography in management of patients with hypertrophic cardiomyopathy (review)https://orcid.org/0000-0003-3984-8482ТарадинГ. Г.TaradinG. G.

Тарадин Геннадий Геннадьевич - кандидат медицинских наук, доцент, заведующий кафедрой терапии факультета интернатуры и последипломного образования им. профессора А.И. Дядыка.

283003, Донецк, проспект Ильича, д. 16

Gennady G. Taradin - Cand. Sci. (Med.), Associate Professor, Head of the Department of Therapy Faculty of Internship and Postgraduate Education named after Professor A.I. Dyadyk.

16, Ilyich Ave., Donetsk, 283003

taradin@inbox.ruhttps://orcid.org/0000-0003-3611-1186ИгнатенкоГ. А.IgnatenkoG. A.

Игнатенко Григорий Анатольевич - доктор медицинских наук, профессор, ректор, заведующий кафедрой пропедевтики внутренних болезней.

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Grigoriy A. Ignatenko - Dr. Sci. (Med.), Professor, Head of the Department Propaedeutics of Internal Diseases, Rector.

16, Ilyich Ave., Donetsk, 283003

gai-1959@mail.ruhttps://orcid.org/0000-0003-2694-6614РакитскаяИ. В.RakitskayaI. V.

Ракитская Ирина Валериевна - кандидат медицинских наук, доцент кафедры терапии факультета интернатуры и последипломного образования им. профессора А.И. Дядыка.

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Irina V. Rakitskaya - Cand. Sci. (Med.), Assistant Professor of the Department of Therapy Faculty of Internship and Postgraduate Education named after Professor A.I. Dyadyk.

16, Ilyich Ave., Donetsk, 283003

rakytskaya@yandex.ruДонецкий государственный медицинский университет имени М. ГорькогоРоссияDonetsk State Medical University named after M. GorkyRussian Federation202322102023016128136Copyright © Тарадин Г.Г., Игнатенко Г.А., Ракитская И.В., 20232023Тарадин Г.Г., Игнатенко Г.А., Ракитская И.В.Taradin G.G., Ignatenko G.A., Rakitskaya I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7809

Представленный обзор посвящен обсуждению роли эхокардиографии (ЭхоКГ) в ведении пациентов с гипертрофической кардиомиопатией (ГКМП). Приведены общие сведения о роли ЭхоКГ в диагностике заболевания, уточнении специфической этиологии гипертрофии и дифференциальной диагностики с вторичной гипертрофией и фенокопиями ГКМП. Подробно обсуждаются особенности гипертрофии правого и левого желудочка (ЛЖ), определение ее преимущественной локализации, фенотипа, значение традиционно используемых параметров оценки гипертрофии миокарда, включая максимальную толщину стенки ЛЖ, массу миокарда и индекс массы миокарда ЛЖ. Знание фенотипических вариантов помогает диагностировать ГКМП, дифференцированно подходить к ведению пациентов и выбору оптимальной стратегии лечения. Особое внимание уделено оценке структуры и функции митрального клапана (МК), подклапанного аппарата и феномена переднесистолического движения, ответственного за развитие обструкции выносящего тракта ЛЖ. Существовавшее ранее мнение, что поражение сердца при ГКМП ограничено лишь гипертрофией миокарда желудочков, в последнее время претерпело изменения. Примерно у 60% пациентов с диагнозом «ГКМП» выявляют, по крайней мере, одну аномалию МК как прямое следствие генетических мутаций. К частым признакам, которые удается выявить с помощью ЭхоКГ, относят удлинение створок и хорд МК, пролапс створок, гипертрофию, диспозицию и изменение числа папиллярных мышц. Подчеркивается важность и значение оценки систолической и диастолической функций ЛЖ. Обсуждается также роль трансэзофагеальной ЭхоКГ в визуализации гипертрофии, особенностей строения МК и в периоперационном периоде во время выполнения процедур по хирургической коррекции гипертрофированной межжелудочковой перегородки и клапанных дефектов.

The presented contains the discussion about the role of echocardiography in management of patients with hypertrophic cardiomyopathy (HCM). The article provides general information about the role of echocardiography in the diagnosis of the disease, clarification of the specific etiology of hypertrophy and differential diagnosis with secondary hypertrophy and phenocopies of HCMP. The features of right and left ventricular (LV) hypertrophy, determination of its predominant localization, phenotype, and conventionally used parameters for assessing myocardial hypertrophy, including the maximum LV wall thickness, LV myocardial mass and LV myocardial mass index, are discussed in detail. Knowledge of phenotypic variants helps to diagnose HCMP, to differentiated approach the management of patients and to choose the optimal treatment strategy. Special attention is paid to the assessment of the structure and function of the mitral valve (MV), the subvalvular apparatus and the phenomenon of systolic anterior motion of the MV responsible for the development of obstruction of the LV outflow tract. The previously existing opinion that cardiac abnormality in HCMP is limited only by hypertrophy of ventricular myocardium has recently undergone changes. Approximately 60% of patients with HCMP have at least one MV anomaly as a direct consequence of genetic mutations. The most common abnormalities that can be detected with echocardiography include elongation of the valvular leaflets and chords, prolapse of the valvular leaflets, hypertrophy, disposition and change in the number of papillary muscles. The importance and significance of assessing LV systolic and diastolic functions using echocardiography is emphasized. The role of transesophageal echocardiography in visualization of hypertrophy features of the MV structure and in the perioperative period during surgical correction of hypertrophied septum and valvular defects is also discussed.

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The authors declare that there are no conflicts of interest present.