Objective To compare the functional parameter and late gadolinium enhancement( LGE)character between asymmetrical septal hypertrophy(ASH)and apical hypertrophic cardiomyopathy(APH),and to evaluate the value of cardiac magnetic resonance(CMR)in diagnosis of APH. Methods A total of 52 HCM patients who went to Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2013 to December 2014,were selected as study subjects,among these cases,there were 40 cases of ASH( ASH group) and 12 cases of APH( APH group),the data of cases were retrospectively reviewed. All cases underwent CMR,myocardial involvement segments were observed,EDⅤ,LⅤEF,myocardial mass,end - diastolic ventricular wall thickness of various segments,and LGE character were measured quantitatively. Results There was no significant difference in LⅤEF between ASH group and APH group(P > 0. 05);EDⅤ of patients in APH group was significantly lower than that of patients in ASH group,myocardial mass of patients in APH group was significantly higher than that of patients in ASH group(P < 0. 05). The incidence of myocardial fibrosis of ASH group was significantly higher than that of APH group〔57. 5% (23 / 40)vs. 41. 7% (5 / 12),χ2 = 5. 070,P < 0. 05〕,and the proportion of fibrotic myocardial mass in the total myocardial mass in ASH group was significantly higher than that in APH group(17. 9% vs. 10. 8% ,χ2 = 1. 976,P <0. 05). And the proportion of fibrotic myocardial mass in the total myocardial mass was positively correlated with ventricular wall thickness of apical segment(r = 0. 780,P < 0. 05). Conclusion According to morphology,cardiac functional parameters and LGE character,CMR can make diagnosis and the differential diagnosis of ASH and APH. LGE lesions of ASH and APH lay mainly in area with obvious morphological change,and LGE indicates myocardial fibrosis,which provides information for clinical therapy.%目的：对比非对称性肥厚型心肌病（ASH）与心尖肥厚型心肌病（APH）心肌形态功能学和延迟增强特点，评估心脏磁共振成像（CMR）检查在诊断 APH 中的临床价值。方法回顾性分析2013年1月—2014年12月首都医科大学附属北京安贞医院就诊的肥厚型心肌病（HCM）患者52例，ASH 40例（ASH 组），APH 12例（APH 组）。患者均行 CMR 检查，观察心肌受累节段，定量测量左心室舒张末期容积（EDⅤ）、左心室射血分数、心肌质量、各节段舒张末期室壁厚度及延迟增强特点。结果 ASH 组与 APH 组患者左心室射血分数比较，差异无统计学意义（ P ＞0.05）；APH 组患者 EDⅤ低于 ASH 组，心肌质量高于 ASH 组（P ＜0.05）。ASH 组患者心肌纤维化发生率〔57.5％（23/40）与41.7％（5/12）〕及纤维化心肌质量占心尖部心肌质量的比重（17.9％与10.8％）高于 APH 组（χ2值分别为5.070和1.976，P ＜0.05）。纤维化心肌质量占心尖部心肌质量的比重与心尖段室壁厚度呈正相关（r ＝0.780，P＜0.05）。结论 CMR 从形态、功能改变及延迟增强病灶特点等方面可诊断、鉴别诊断 ASH 及 APH。ASH 和 APH 延迟增强范围均主要位于形态改变明显区域，且延迟增强提示心肌纤维化，其对于临床治疗有一定指导意义。
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