Objective:To evaluate the right atrial volume and function abnormalities in patients with pulmonary hypertension (PH) by four-dimensional automatic quantitation technique, and to explore the application value of this technique in evaluating the risk stratification and World Health Organization functional class(WHO-FC) of PH patients.Methods:Eighty-four adult patients with PH diagnosed by right heart catheterization from April to October 2022 in Fuwai Central China Cardiovascular Hospital were consecutively enrolled as the PH group. All cases were divided into 3 groups according to the mean pulmonary arterial pressure (mPAP): mild PH group ( n=28), moderate PH group ( n=28), severe PH group ( n=28). Twenty-eight healthy volunteers matched by gender and age were included in the same period as the control group. The volume and strain parameters of the right atrium were obtained by analyzing the four-dimensional image of the right atrium using four-dimensional automatic quantitation technique, including right atrial minimum volume index (RAVImin), right atrial maximum volume index (RAVImax), right atrial presystolic volume index (RAVIpreA), right atrial ejection fraction (RAEF), right atrial passive ejection fraction (RAPEF), right atrial active ejection fraction, RAAEF, longitudinal strains of right atrial reserve, conduit and systolic period (RASr, RAScd, RASct), circumferential strains of right atrial reserve, conduit and systolic period (RASr-c, RAScd-c, RASct-c). The differences in right atrial parameters among four groups were compared.ROC curve was used to analyze the diagnostic efficiency of right atrial four-dimensional strain parameters for PH patients with WHO-FC≥Ⅲ. Pearson linear correlation analysis was used to investigate the relationships between RASr and right atrial area (RAA), NT-proBNP and tricuspid annular plane systolic excursion to pulmonary arterial systolic pressure ratio (TAPSE/sPAP). Results:①Compared with the control group, RAEF, RAPEF, RASr, RAScd, RASr-c, RAScd-c were significantly decreased in mild, moderate and severe PH groups; while RAAEF, RASct, RASct-c were significantly increased in mild PH group and significantly decreased in moderate and severe PH groups, and the differences were statistically significant (all P<0.05). RAVImin, RAVImax, RAVIpreA gradually increased among the control, mild PH, moderate PH and severe PH groups, and the differences were statistically significant (all P<0.05). RAEF, RAPEF, RAAEF, RASr, RAScd, RASct, RASr-c, RAScd-c, RASct-c were decreased successively among mild, moderate and severe PH groups, and the differences were statistically significant (all P<0.05). ②ROC curve showed that RASr had the highest diagnostic efficiency in PH patients with WHO-FC ≥Ⅲ, and the cut-off value was 20.5% (AUC=0.914, P<0.001). ③Correlation analysis showed that RASr was correlated with RAA, NT-proBNP and TAPSE/sPAP ( r=-0.803, -0.621, 0.739; all P<0.001). Conclusions:The degree of right atrial function impairment increased in patients with mild, moderate and severe PH in turn. RASr is the best predictor of WHO-FC ≥Ⅲ in patients with pulmonary hypertension and is a potential parameter for risk stratification in patients with PH.

目的 分析成人暴发性心肌炎(fulminant myocarditis,FM)的超声心动图特点,探讨超声心动图在FM诊疗中的应用价值.方法 回顾性收集2018年4月 ～2021年3月于阜外华中心血管病医院就诊的36例成人FM患者的临床及超声心动图资料,按照出院时左心室射血分数(left ventricular ejection fraction,LVEF)是否≥50％将患者分为恢复组(n=24)和未恢复组(n=12),对两组的临床及超声心动图资料进行统计学分析,比较两组间资料差异.结果 FM患者的超声表现多样,36例患者中入院时所有患者左心室室壁运动和LVEF均减低,其中瓣膜反流者35例,左心室室壁增厚者2例,左心室增大者12例,心包积液者13例,合并心腔内血栓者2例;恢复组的入院LVEF、左心室短轴缩短率及住院期间最低LVEF明显高于未恢复组(32.46％ ±8.65％vs 23.58％ ±8.21％,15.58％ ±4.61％vs 11.08％ ±4.10％,29.46％ ±8.82％vs 18.92％ ±7.05％),差异均有统计学意义(P均<0.05).结论 超声心动图在成人FM诊疗中具有重要临床价值.

目的 探讨改构型酸性成纤维细胞生长因子(MaFGF)纳米脂质体(NP)结合超声靶向微泡爆破技术(UTMD)对阿霉素心肌病(DOX-CM)大鼠心肌细胞凋亡的影响及机制.方法 随机将50只健康雄性SD大鼠分为:正常对照组、DOX-CM模型组、MaFGF溶液组、MaFGF-NP组及MaFGF-NP+UTMD组(n=10).干预6周后,应用超声心动图测定所有大鼠的左心室舒张末期内径(LVIDd)、左心室收缩末期内径(LVIDs)、左心室射血分数(LVEF)和左心室短轴缩短率(LVFS).实验结束后,取大鼠心肌组织,通过TUNEL荧光染色法观察心肌细胞凋亡情况,蛋白免疫印迹法测定心肌凋亡相关蛋白表达.结果 与DOX-CM模型组比较,MaFGF-NP+UTMD组LVIDs及LVIDd明显减小,LVEF、LVFS明显增高,而TUNEL染色结果显示,MaFGF-NP+UTMD组大鼠心肌细胞凋亡明显减少;蛋白免疫印迹法检查结果显示,MaFGF-NP+UTMD组较DOX-CM模型组pAKT/AKT比值和BAX的含量减低,BCL-2的含量升高.结论 MaFGF-NP结合UTMD可减轻阿霉素所致心肌损伤,其机制可能与MaF-GF减少阿霉素引起的心肌细胞凋亡有关.

Ultrasound-mediated microbubble cavitation (UMMC) induces therapeutic angiogenesis to treat ischemic diseases. This study aimed to investigate whether diagnostic UMMC alleviates diabetic cardiomyopathy (DCM) and, if so, through which mechanisms. DCM model was established by injecting streptozocin into rats to induce hyperglycemia, followed by a high-fat diet. The combined therapy of cation microbubble with low-intensity diagnostic ultrasound (frequency = 4 MHz), with a pulse frequency of 20 Hz and pulse length (PL) of 8, 18, 26, or 36 cycles, was given to rats twice a week for 8 consecutive weeks. Diagnostic UMMC therapy with PL at 8, 18, and 26 cycles, but not 36 cycles, dramatically prevented myocardial fibrosis, improved heart functions, and increased angiogenesis, accompanied by increased levels of PI3K, Akt, and eNOS proteins in the DCM model of rats. In cultured endothelial cells, low-intensity UMMC treatment (PL = 3 cycles, sound pressure level = 50%, mechanical index = 0.82) increased cell viability and activated PI3K-Akt-eNOS signaling. The combination of diagnostic ultrasound with microbubble destruction dose-dependently promoted angiogenesis, thus improving heart function through PI3K-Akt-eNOS signaling in diabetes. Accordingly, diagnostic UMMC therapy should be considered to protect the heart in patients with diabetes.

Objective:To detect the abnormal changes of myocardial blood perfusion in patients with hypertrophic cardiomyopathy (HCM) by myocardial contrast echocardiography(MCE) combined with exercise stress test.Methods:Twenty-seven patients with clinically diagnozed of asymmetric HCM in Fuwai Central China Cardiovascular Hospital from May 2020 to April 2021 were selected as the HCM group, and 29 healthy subjects during the same period were selected as the control group. All patients underwent routine echocardiography, resting and exercise stress MCE. The myocardial perfusion parameters of each segment of interventricular septum in the 2 groups were quantitatively analyzed: the peak plateau intensity (A value), ascending slope of the curve(β value) and value of A×β. According to the end-diastolic myocardial thickness, the interventricular septum of the HCM group was divided into hypertrophic and non-hypertrophic segments, and the myocardial contrast parameters of the interventricular septum of the study group were compared with those of the control group. The myocardial blood flow reserve value of the two groups were calculated, and the correlation of myocardial blood flow reserve value with left ventricular mass index (LVMI) and left ventricular remodeling index (LVRI) were analyzed.Results:No matter at rest or under stress, the A value, β value and A×β value of ventricular septal hypertrophic and non-hypertrophic segments in the hypertrophic cardiomyopathy group were lower than those in the control group, and the differences were statistically significant (all P<0.05). Under stress, the A value, β value and A×β value of interventricular septal hypertrophic segments were lower than those in non-hypertrophic segments in the HCM group, and the differences were statistically significant (all P<0.05). The myocardial blood flow reserve in the HCM group was negatively correlated with LVMI and LVRI( r=-0.899, -0.676; all P<0.001). Conclusions:In patients with HCM under resting and exercise stress, microcirculation disorders were found in both hypertrophic and non-hypertrophic segments of the ventricular wall, and the myocardial blood flow reserve was negatively correlated with LVMI and LVRI.

目的 探究艾司西酞普兰应用于急性心肌梗死后静脉溶栓患者的效果.方法 选取我院2019年1月～2021年1月期间收治的急性ST抬高型心肌梗死溶栓患者82例,根据随机数字表法分组.对照组41例常规治疗,观察组41例加用艾司西酞普兰,对比两组患者心肌损伤标志物、躯体化症状、心功能、焦虑、抑郁情绪.结果 治疗后两组肌酸激酶同工酶(CK-MB)、心肌钙蛋白(cTnT)、N末端脑钠肽前体(NT-proBNP)水平无统计学意义(P＞0.05);治疗后观察组躯体化症状自评量表(SSS)、广泛性焦虑障碍量表(GAD-7)、健康问卷抑郁自评量表(PHQ-9)评分、左室舒张末期容积指数(LVEDVI)、左室收缩末期容积指数(LVESVI)水平低于对照组,左室射血分数(LVEF)水平高于对照组,有统计学意义(P＜0.05).结论 艾司西酞普兰联合常规措施对急性ST抬高型心肌梗死静脉溶栓患者治疗,可有效改善心功能,降低躯体化症状和焦虑抑郁情绪.

Background Microvascular insufficiency plays an important role in the development of diabetic cardiomyopathy (DCM), therapeutic angiogenesis has been mainly used for the treatment of ischemic diseases. This study sought to verify the preclinical performance of SonoVue microbubbles (MB) combined ultrasound (US) treatment on myocardial angiogenesis in the rat model of DCM and investigate the optimal ultrasonic parameters. Methods The male Sprague–Dawley (SD) rats were induced DCM by streptozotocin through intraperitoneal injecting and fed with high-fat diet. After the DCM model was established, the rats were divided into the normal group, DCM model group, and US + MB group, while the US + MB group was divided into four subsets according to different pulse lengths (PL) (8 cycles;18 cycle;26 cycle; 36 cycle). After all interventions, all rats underwent conventional echocardiography to examine the cardiac function. The rats were sacrificed and myocardial tissue was examined by histology and morphometry evaluations to detect the myocardial protective effect of SonoVue MBs using US techniques. Results From morphologic observation and echocardiography, the DCM rats had a series of structural abnormalities of cardiac myocardium compared to the normal rats. The US-MB groups exerted cardioprotective effect in DCM rats, improved reparative neovascularization and increased cardiac perfusion, while the 26 cycle group showed significant therapeutic effects on the cardiac functions in DCM rats. Conclusion This strategy using SonoVue MB and US can improve the efficacy of angiogenesis, even reverse the progress of cardiac dysfunction and pathological abnormalities, especially using the 26 cycle parameters. Under further study, this combined strategy might provide a novel approach for early intervention of DCM in diabetic patients.

The purpose of this study was to evaluate the protective effect of acidic fibroblast growth factor targeted mediated by novel nanoparticles–cationic lipid microbubbles complex (aFGF–NP + CPMBs) combined with ultrasound targeted microbubble destruction (UTMD)on doxorubicin–induced heart failure (HF)and its mechanism. Heart failure rats induced by intraperitoneal injection with doxorubicin (DOX) to achieve cummulative dose of 15mg/kg for continuous 6 weeks showed left ventricular dysfunction, seriously oxidative stress, cardiomyocyte apoptosis, and decrease of myocardial vascular density. In contrast, aFGF–NP + CPMBs combined with UTMD therapy (3ug/kg, caudal vein injection, twice a week, 6weeks)prominently ameliorated left ventricular dysfunction by increased ejection fraction (EF) and fractional shortening (FS), decreased brain natriuretic peptide (BNP); strengthened the ability of antioxidant stress confirmed by increasing the activity of SOD and reducing the production of MDA; exerted the effect of anti–cardiomyocyte apoptosis and promotion angiogenesis by inhibited Bax expression and increased Bcl–2 expression and platelet endothelial cell adhesion molecule (CD31) expression. Taken together, the research suggested that aFGF targeted mediated by novel nanoparticles–cationic lipid microbubbles complex combined with UTMD should be a promising targeted treatment for heart failure.

目的 观察急性心肌梗死合并心力衰竭患者主动脉球囊反搏(intra-aortic balloon pump,IABP)治疗前、后左心室收缩功能变化,探讨二维斑点追踪技术评价IABP治疗效果的应用价值.方法 33例急性心肌梗死合并心力衰竭患者均采用IABP治疗.应用二维斑点追踪技术检测治疗前、后左心室整体收缩期纵向峰值应变(global longitudinal peak strain,GLS),包括四腔观GLS、三腔观GLS、两腔观GLS、平均GLS和左心室峰值纵向应变离散度;比较治疗前、后左心室舒张末期容积、左心室收缩末期容积、左心室搏出量、左室射血分数.结果 IABP治疗后,33例患者左室射血分数[(43.27±10.71)％]、四腔观GLS[(9.53±3.87)％]、三腔观GLS[(9.41±4.30)％]、两腔观GLS[(9.60±3.32)％]、平均GLS[(9.00±3.60)％]均高于治疗前[(37.03±12.95)％、(7.28±3.21)％、(6.81±2.99)％、(7.35±3.15)％、(7.15±2.77)％](P<0.05),左心室峰值纵向应变离散度[(58.12±19.89)s]低于治疗前[(75.27±26.85)s](P<0.05),左心室舒张末期容积[(114.03±30.61)mL]、左心室搏出量[(48.48±16.33)mL]和左心室收缩末期容积[(65.42±25.15)mL]与治疗前[(113.76±31.77)、(40.94±17.68)、(72.88±29.67)mL]比较差异均无统计学意义(P>0.05).结论 IABP可改善急性心肌梗死合并心力衰竭患者左心室收缩功能.左心室整体收缩期GLS及峰值应变离散度可为临床评价IABP治疗效果提供客观依据.

目的 探讨分层应变技术在2型糖尿病(type 2 diabetes mellitus,T2DM)并冠状动脉微循环障碍(coronarymicrovascular dysfunction,CMD)患者左心室收缩功能评估中的应用价值.方法 45例T2DM患者,均行核素心肌灌注显像检查,提示存在CMD者24例为糖尿病A组,无CMD者21例为糖尿病B组;同期30例体检健康者为对照组.3组行超声心动图检查测量左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDd)、左心室收缩末期内径(left ventricular end-systolic dimension,LVEDs)、左室射血分数(left ventricular ejection fraction,LVEF)、室间隔厚度(interventricular septal thickness,IVST)、左心室后壁厚度(left ventricular posterior wall thickness,LVPW);采集左心室心尖两腔、三腔及四腔的二维灰阶动态图像,分析后得到左心室心肌整体内层纵向应变(global longitudinal strain of the endocardium,GLSendo)、整体中层纵向应变(global longitudinal strain of the mid-myocardium,GLSmid)、整体外层纵向应变(global longitudinal strain of the epicardium,GLSepi)及峰值应变离散度(peak strain dispersion,PSD),并进行比较.结果 糖尿病A组、糖尿病B组、对照组LVEDd[(43.92±3.51) 、(43.11±3.84)、(43.86±3.94) mm]、LVEDs[(28.46±2.24)、(28.29±2.02)、(28.33±2.50)mm]、LVEF[(64.71±3.28)％、(65.82±3.89)％、(65.87±3.39) ％]、IVST[(10.04±0.56)、(10.23±0.61)、(10.01±0.55)mm]、LVPW[(9.69±0.49)、(9.87±0.42)、(9.73±0.46)mm]比较差异均无统计学意义(P＞0.05);糖尿病A组、糖尿病B组、对照组左心室心肌GLSendo[(23.26±1.42)％、(25.76±1.48)％、(27.20±1.99)％]、GLSmid[(20.02±0.98)％、(22.30±1.29)％、(23.61±1.48)％]、GLSepi[(17.56±0.95)％、(19.96±1.11)％、(20.98±1.11)％]依次增高(P＜0.05),PSD[(37.87±7.47)、(31.29±5.99)、(23.24±4.16)ms]依次减低(P＜0.05).结论 分层应变技术可检测T2DM并CMD患者左心室收缩功能改变.

Objective:To investigate the effects of modified acidic fibroblast growth factor (MaFGF) mediated by nanoliposomes combined with ultrasound-targeted microbubble destruction (UTMD) on left ventricular systolic function in early diabetes mellitus(DM) rats.Methods:The nanoliposomes containing MaFGF(MaFGF-nlip) were prepared by reverse phase evaporation method. Among 60 male Sprague Dawley (SD) rats, 50 rats were randomly selected and were induced to be DM models by streptozotocin(STZ) through intraperitoneal injecting, the other 10 rats as control group. Then DM rats were randomly divided into 4 groups: DM model group, MaFGF solution group, MaFGF-nlip group and MaFGF-nlip+ UTMD group. After the successful induction of DM model, the intervention was performed twice a week.After 12 weeks of intervention, all rats underwent conventional echocardiography and velocity vector imaging (VVI). Left ventricular ejection fraction (LVEF) and left ventricular fraction shortening(LVFS) were measured by conventional echocardiography. The mean peak systolic radial velocity (Vs), radial strain (Sr) and radial strain rate (SRr) of six walls at the papillary muscle level were measured in left ventricular short-axis view by VVI. At last, myocardial tissue of all rats were stained with Sirius red to evaluate myocardial interstitial fibrosis. The level of myocardial apoptosis was evaluated by TUNEL staining, and the changes of myocardial ultrastructure were observed by transmission electron microscopy.Results:The prepared MaFGF-nlip were more rounded, evenly dispersed, and of good stability and high encapsulation efficiency. Twelve weeks later after intervention, LVEF, LVFS, Vs, Sr and SRr in the DM model group were significantly lower than those in the control group (all P<0.05). LVEF, LVFS, Vs, Sr and SRr in the MaFGF-nlip+ UTMD group were significantly higher than those of the DM model group and other intervention groups (all P<0.05). The results of Sirius red staining and Tunel staining showed that CVF and AI in the DM model group were significantly higher than those in the control group (all P<0.05). For MaFGF-nlip+ UTMD group, CVF and AI were significantly decreased compared with the DM model group and other intervention groups(all P<0.05). According to the results of transmission electron microscopy, compared with the DM model group, the improvement of myocardial ultrastructure was the most obvious in the MaFGF-nlip+ UTMD group. Conclusions:MaFGF delivered by using nanoliposomes combined with UTMD can improve the left ventricular systolic function in diabetic rats by inhibiting the myocardium cardiac fibrosis and reducing the cardiomyocyte apoptosis.

Objective:To observe the effect and mechanism of diagnostic low intensity ultrasound combined with microbubbles on myocardial microcirculation in rats with diabetic cardiomyopathy (DCM).Methods:The healthy male SD rats were induced DCM by streptozotocin through intraperitoneal injection and fed with high fat diet. The rats were randomly divided into normal control group ( n=15), DCM model group (DCM group, n=15), and the SonoVue microbubble + US group (US+ MB group, n=15). After 2 weeks of intervention using diagnostic ultrasound combined with VFLASH, all rats underwent conventional echocardiograph to examine the cardiac function. The rats were sacrificed and myocardial tissue was stained with CD31 immunohistochemistry to quantify myocardial microvascular density (MVD). The expressions of PI3K-Akt-eNOS pathway protein in rats myocardium were detected by Western blot. Results:The left ventricular ejection fraction (LVEF) and left ventricular fraction shortening (LVFS) in the US+ MB grouph were significantly increased compared with DCM group [(68.97±4.84) % vs (57.76±6.03)%, (34.01±3.97)% vs (27.70±3.24)%, all P<0.05]. The MVD in US+ MB group was significantly higher than that in the DCM group(27.66±3.39 vs 10.67±1.63, P<0.05). The protein level of phosphatidylinositol 3-kinase(PI3K), protein kinase B(PKB/Akt) and PI3K phosphorylation in myocardial tissue of rats increased significantly in US+ MB group compared with DCM group [(0.44±0.04)% vs (0.28±0.05)%, (0.36±0.04)% vs (0.21±0.05)%, (0.42±0.06)% vs (0.26±0.05)%, all P<0.05]. However, the protein level of endothelial nitric oxide synthase(eNOS) and p-eNOS were slightly increased in US+ MB group, but there was no obvious statistical difference compared to the DCM group [(0.37±0.05)% vs (0.29±0.07)%, (0.26±0.05)% vs (0.23±0.03)%, all P>0.05]. Conclusions:Diagnostic low intensity ultrasound combined with microbubbles can enhance myocardial microcirculation and improve myocardial function to some extent, and the mechanism may be related to the activation of PI3K-Akt-eNOS pathways.

The authors have withdrawn this preprint due to author disagreement.

Objective:To investigate the clinical value of evaluating left ventricular myocardial strain before and after myocardial infarction using a vendor-independent three-dimensional analysis software (Tomtec).Methods:Ten freshly harvested porcine hearts were connected to a pulsatile pump apparatus, and the stroke volume was set to 30 - 70 ml. Ultrasound sono micrometry crystals were sutured to the epicardium to obtain the corresponding myocardial strain value as the strain gold standard. GE ultrasound machines were used to obtain three-dimensional images of left ventricular full volume before and after myocardial infarction (5 porcine hearts were used to prepare a model of myocardial infarction), and longitudinal strain and circumferential strain were obtained by Tomtec analysis software, and the correlations was analyzed.Results:The longitudinal strain and circumferential strain measured by Tomtec software in normal myocardial and myocardial infarction models were related to the data obtained by sono micrometric method, with longitudinal strain r=0.85 and 0.83, and circumferential strain r= 0.82 and 0.83. Compared with normal myocardium, the longitudinal and circumferential strains of GE ultrasound system measured by Tomtec method after myocardial infarction were reduced by 30.4% and 34.4%, respectively. Conclusions:All images acquired on GE Vivid 9 echocardiographic systems are able to be analyze with Tomtec software and these images correlate well with sono-micrometry.Tomtec three-dimensional left ventricular analysis software can be applied to clinical multicenter collaborative research, providing a theoretical basis for the consistency of research results.

Objective:To explore the clinical value of adenosine stress myocardial contrast echocardiography in detecting myocardial blood perfusion abnormalities in patients with type 2 diabetes mellitus.Methods:Twenty-six patients with type 2 diabetes mellitus clinically diagnosed from May 2019 to January 2020 in the endocrinology department of Fuwai Central China Cardiovascular Hospital and 28 healthy examinees with gender and age matched during the same period were enrolled. Routine echocardiography, rest and adenosine stress myocardial contrast echocardiography were performed, the plateau signal intensity(A value), curve rising slope(K value) and A×K value of the myocardial perfusion time-intensity curve were obtained by offline analysis. And general data such as age, gender, disease course, body mass index and glycated hemoglobin were collected, and results of the two groups were compared statistically.Results:In the rest state, the A value of the myocardial perfusion parameter in the diabetic group was not significantly different from that of the control group, both in whole and in segments ( P>0.05), while the K value and A×K value of the myocardial perfusion parameters in the diabetic group were significantly lower than those in the control group ( P<0.05). In the stress state, the A value, K value and A×K value of myocardial perfusion parameters in the diabetic group were significantly lower than those in the control group, both in whole and in segments ( P<0.05). The detection rate of myocardial perfusion abnormality in the stress state was significantly higher than that in the rest state, and the difference was statistically significant ( P<0.05). The myocardial blood flow reserve in the diabetic group was negatively correlated with the course of disease and the level of glycated hemoglobin ( r=-0.580, P=0.020; r=-0.481, P=0.013). Conclusions:Adenosine stress myocardial contrast echocardiography can be used for detection of left ventricular myocardial perfusion abnormalities in patients with type 2 diabetes mellitus, which has great clinical application value.

糖尿病除增加冠心病和高血压患病风险外,还会影响糖尿病患者的心肌微循环,从而增加心力衰竭的发病风险.心肌超声造影是一种利用超声微泡造影剂和超声心动图检查相结合来评价心肌微循环灌注和心肌功能的重要检查方法,可对心肌微循环功能进行动态评估,具有价格低廉、操作简单等特点,近年已逐渐应用于各种心肌病变的评估.本文就心肌超声造影在糖尿病心肌病心肌微循环障碍评价中的应用进展作一综述.

Acidic fibroblast growth factor (FGF1) has great potential in preventing diabetic cardiomyopathy. This study aimed to evaluate the preventive effect of FGF1-loaded nanoliposomes (FGF1-nlip) combined with ultrasound-targeted microbubble destruction (UTMD) on diabetic cardiomyopathy (DCM) using ultrasound examination. Nanoliposomes encapsulating FGF1 were prepared by reverse phase evaporation. DM model rats were established by intraperitoneal injection of streptozotocin (STZ), and different forms of FGF1 (FGF1 solution, FGF1-nlip, and FGF1-nlip+UTMD) were used for a 12-week intervention. According to the transthoracic echocardiography and velocity vector imaging (VVI) indexes, the LVEF, LVFS, and VVI indexes (Vs, Sr, SRr) in the FGF1-nlip+UTMD group were significantly higher than those in the DM model group and other FGF1 intervention groups. From the real-time myocardial contrast echocardiography (RT-MCE) indexes, the FGF1-nlip+UTMD group A and A×β showed significant differences from the DM model group and other FGF1 intervention groups. Cardiac catheter hemodynamic testing, CD31 immunohistochemical staining, and electron microscopy also confirmed the same conclusion. These results confirmed that the abnormalities, including myocardial dysfunction and perfusion impairment, could be suppressed to different extents by the twice weekly FGF1 treatments for 12 consecutive weeks (free FGF1, FGF1-nlip, and FGF1-nlip+UTMD), with the strongest improvements observed in the FGF1-nlip+UTMD group. In conclusion, the VVI and RT-MCE techniques can detect left ventricular systolic function and perfusion changes in DM rats, providing a more effective experimental basis for the early detection and treatment evaluation of DCM, which is of great significance for the prevention of DCM.

目的 应用二维应变成像及峰值应变离散度(peak strain dispersion,PSD)评价房间隔缺损(atrial septal defect,ASD)经皮介入封堵术对左心室收缩功能及运动同步性的影响.方法 经皮介入封堵术治疗的ASD患者39例为ASD组,健康志愿者40例为对照组.采集连续3个心动周期心尖二腔心观、心尖三腔心观及心尖四腔心观3个长轴切面的二维动态图像,由EchoPAC定量分析软件自动计算出左心室三腔观纵向峰值应变(global longitudinal peak strain of apical long-axis,GLPS-LAX)、左心室四腔观纵向峰值应变(global longitudinal peak strain of apical four-chamber,GLPS-4AC)、左心室二腔观纵向峰值应变(global longitudinal peak strain of apical two-chamber,GLPS-2AC)、左心室平均纵向峰值应变(average global longitudinal peak strain,GLPS-AVG)及左心室18节段PSD.比较ASD组与对照组及ASD组手术前、后各参数的差异.结果 ASD组术前GLPS-LAX[(16.11±5.85)％]、GLPS-4AC[(17.07±3.96)％]、GLPS-2AC[(18.48±4.64)％]及GLPS-AVG[(17.22±3.67)％]均低于对照组[(20.09±3.18)％、(20.36±3.19)％、(20.70±3.19)％、(20.38±2.58)％](P＜0.05),PSD[(56.56±14.25)ms]高于对照组[(33.25±5.53)ms](P＜0.05);ASD组术后1 d GLPS LAX[(20.22±4.05)％]、GLPS-4AC[(18.28±3.75)％]、GLPS-2AC [(20.14±3.58)％]及GLPS-AVG[(19.55±2.76)％]均高于手术前(P＜0.05),PSD[(41.72±12.22) ms]低于手术前(P＜0.05).结论 ASD经皮介入封堵术可改善左心室收缩功能及运动同步性,应变成像及PSD为ASD介入治疗效果评价提供了新方法.

目的 探讨超声在Bentall术后冠状动脉吻合口漏并假性动脉瘤形成诊断中的应用价值.方法 选取我院Bentall术后经主动脉造影检查确诊且超声提示冠状动脉吻合口漏并假性动脉瘤形成的16例患者,总结其二维超声及彩色多普勒超声征象,并与主动脉造影结果进行对比分析.结果 16例患者人工血管周围二维超声均可探及搏动性无回声区;冠状动脉吻合口处彩色多普勒可显示异常血流信号,其中左侧9例,右侧7例;瘤体均位于人工血管旁.经胸超声测量假性动脉瘤瘤体最大径和漏口处血流束宽度与主动脉造影诊断结果比较差异均无统计学意义.结论 超声可以准确诊断Bentall术后冠脉吻合口漏及并发的假性动脉瘤,可作为临床随访检查的首选方法.

目的 观察超声靶向微泡击破(UTMD)技术调控改构型酸性成纤维细胞生长因子(MaFGF)对阿霉素心力衰竭(HF)大鼠心功能的保护作用并探讨其机制.方法 随机将40只实验动物(雄性健康SD大鼠)分为正常对照组、HF模型组、MaFGF组和MaFGF+UTMD组.后3组大鼠通过腹腔注入盐酸阿霉素,MaFGF+UTMD组大鼠经尾静脉注射内含MaFGF的超声微泡混悬液后心脏接受超声靶向微泡击破处理.经过6周干预,超声心动图检查测量左心室收缩末期内径(LVESd)、左心室舒张末期内径(LVEDd)、左心室短轴缩短率(LVFS)以及左心室射血分数(LVEF).其后处死大鼠取心肌组织,检测心肌丙二醛(MDA)、超氧化物歧化酶(SOD)水平,通过Masson胶原染色计算心肌胶原容积分数(CVF)、血管周围胶原面积(PVCA)/血管腔面积(LA)比值,透射电镜下对心肌细胞超微结构进行观察.结果 经过干预6周后,MaFGF+UTMD组LVESd及LVEDd较HF模型组减小(均P<0.05),LVEF、LVFS增高(均P<0.05);HF模型组心肌MDA较正常对照组升高,而SOD降低(均P<0.05),经过MaFGF+UTMD干预,MaFGF+UTMD组SOD上升而MDA降低(均P<0.05);Masson胶原染色显示与正常对照组比较HF模型组CVF与PVCA/LA增高(均P<0.05),而MaFGF+UTMD组这两项指标则下降(均P<0.05);透射电镜显示HF大鼠心脏结构明显异常且能量代谢紊乱,而由UTMD介导的MaFGF干预后,大鼠的心脏微观形态有所改善.结论 对于由阿霉素诱导的心肌损伤,UTMD介导MaFGF对左心室收缩机能具有保护性,其机制可能与MaFGF缓解ROS损害心肌线粒体膜程度,抑制心肌纤维化的形成有关.