Progress in the treatment of acute myocardial infarction (AMI)， chronic coronary artery disease and their immediate complications has led to an increasing number of surviving patients with residual left ventricular dysfunction. It has been shown that viable myocardium in post-AMI patients and chronic heart failure patients plays an important role in predicting their prognosis and making clinical decisions. Viable myocardium refers to myocardium with reversible contractile dysfunction that occurs in coronary ischemia or after ischemia-reperfusion, but still has contractile reserve. Myocardial microvascular integrity is in correspondence with myocardial viability. Myocardial contrast echocardiography can evaluate the microvascular integrity of myocardial dysfunctional areas in patients with AMI or chronic coronary artery disease, detect viable myocardium， predict the potential for functional recovery in dysfunctional areas following reperfusion， and provide clinicians with valuable information for individualized treatment.
We tried to explore the value of contrast echocardiography (CEcho) on evaluating hypertrophic cardiomyopathy (HCM) with the inferior wall hypertrophy. A total of 114 patients with HCM were investigated. All the patients received CEcho and routine echocardiography (Echo), and 45 of them received cardiac magnetic resonance (CMR) and 47 of them received Holter. The frequency and percentage of inferior wall hypertrophy were analyzed in HCM patients, as well as the structure and function. The results showed that: (1) Inferior wall hypertrophy was detected in 55 patients (48%) by Echo, while 68 patients (60%) by CEcho. (2) There was no significant difference between CMR and CEcho in the measurement of inferior wall at end-diastole and end-systole. Thickness of inferior wall by CEcho tended to be higher than CMR. However, the inferior wall thickness measured by Echo was obviously lower than that by CMR (P < 0.05) and CEcho ( P < 0.05). (3) Bland-Altman plot suggested good consistency between CEcho and CMR in measuring inferior wall thickness. 95% CI of mean differences in inferior wall thickness between CEcho and CMR were smaller in HCM patients as compared with that between Echo and CMR. Unary linear regression analysis showed good degree of fitting between CEcho and CMR. (4) Holter showed that HCM patients with inferior wall hypertrophy were likely to have higher incidence of premature ventricular complexes (PVC) ≥ 500/24 h. We demonstrate that CEcho is rather sensitive in detecting inferior wall hypertrophy. Echo may underestimate the inferior wall thickness. The risk of ventricular premature beats may increase in HCM patients with inferior hypertrophy.
ObjectiveTo systematically review the diagnostic value of contrast transthoracic echocardiography (C-TTE) and contrast transcranial Doppler bubble test (C-TCD) for patent foramen ovale (PFO). MethodsComputer searches were conducted in PubMed, Embase, Web of Science, CNKI, WanFang Data, and CBM databases to collect studies on the diagnostic value of C-TTE and C-TCD for PFO. The retrieval time limit was from the establishment of the databases to September 30, 2024. Two ultrasound diagnostic physicians independently screened the literature, extracted data, and evaluated the risk of bias in the included studies using the QUADAS-2 and QUADAS-C tools. Then, Meta-analysis was performed using Meta-DiSc version 1.4 software and R 4.4.3. ResultsA total of 22 studies including 2 487 patients were included. The results of the meta-analysis showed that for C-TCD in diagnosing PFO, the sensitivity (SEN), specificity (SPE), positive likelihood ratio (+LR), negative likelihood ratio (–LR), and diagnostic odds ratio (DOR) were (0.86, 95% CI 0.81 to 0.90), ( 0.85, 95% CI 0.78 to 0.91), (5.80, 95% CI 3.80 to 9.50), (0.17, 95% CI 0.12 to 0.23), and (34, 95% CI 18.00 to 68.00) respectively; for C - TTE in diagnosing PFO, the SEN, SPE, +LR, –LR, and DOR were (0.81, 95% CI 0.74 to 0.86), (0.92, 95% CI 0.87 to 0.96), (10.2, 95% CI 6.10 to 19.20), (0.21, 95% CI 0.15 to 0.28), and (50, 95% CI 26.00 to 101.00) respectively. The areas under the summary receiver - operating characteristic (SROC) curves (AUC) of C-TCD and C-TTE for diagnosing PFO were 0.90 and 0.85 respectively. ConclusionBoth C-TCD and C-TTE have good sensitivity and specificity in the diagnosis of PFO and can be used as powerful tools for the examination of right-to-left shunt in PFO. However, C-TCD has slightly higher sensitivity and slightly lower specificity than C-TTE. Limited by the number and quality of the included studies, the above conclusions need to be verified by more studies.
