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.

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 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.

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.