| PartⅠClinical study on the quantitative evaluation Of left ventricular wall thickness and left ventricular volume in patients with apical hypertrophic cardiomyopathy by echocardiography left ventricular opacificationObjective:To evaluate the clinical value of measuring the left ventricular wall thickness(LVWT)and left ventricular volume in patients with apical hypertrophic cardiomyopathy(AHCM)by echocardiography left ventricular opacification(LVO).Methods:This prospective case–control study recruited a total of confirmed 27 AHCM patients and 33 normal controls.All subjects underwent conventional transthoracic two dimentional echocardiography(2DE)and LVO,the obtained images including three completed cardiac cycles of apical 4 chamber(AP4C),apical 2 chamber(AP2C),apical 3chamber(AP3C)and short axis views of mitral level,papillary muscle level,apical level.The quantitative analyzed parameters including left atrial end-systolic diameter(LADS),left ventricular end-diastolic diameter(LVDD),left ventricular end-systolic diameter(LVSD),mitral valvular early diastolic inflow velocity(E)and late diastolic inflow velocity(A),mitral annular systolic velocity(s),early diastolic velocity(e)and late diastolic velocity(a),the LVWT of 16 left ventricular segments,left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),stroke volume(SV)and left ventricular ejection fraction(LVEF),and the above parameters were compared between the two groups.The intra-observer repeatability of the LVWTand left ventricular volume by LVO and 2DE were analyzed with the intraclass correlationcoefficient(ICC).Results:(1)Comparison of the general parameters of 2DE: compared to the normal group,LADS,E/ e,A were higher,e,e/a were lower in the AHCM group,the differences were tatistically significant(P<0.001);there were no statistical differences in LVDD,LVSD,E,E/A,a between the two groups(P>0.05).(2)Comparison of the changing trend of LVWT measured by both methods at three short view levels in the two groups : LVWT at three short levels in the two groups measured by LVO were lower than that by 2DE,thedifferences were statistically significant(P<0.001);LVWT gradually decreased from mitral level to apical level in the normal group,while LVWT increased from mitral level to apical level in the AHCM group measured by both 2DE and LVO,the differences were statistically significant among three levels in the two groups(P<0.001).(3)Comparison of LVWT: there was no statistical difference in LVWT at mitral level between the two groups measured by both LVO and 2DE(P>0.05);Compared to the normal group,LVWT at papillary muscle level,Apical level were statistically significant higher in the AHCM group measured by both LVO and 2DE(P<0.001).(4)Comparison of the left ventricular volume and LVEF: The values of LVEDV,LVESV,SV determined by LVO were higher than that by 2DE in the two groups,and the differences were statistically significant(P<0.001),the differences of LVEF measured by both methods in the two groups were not statistically significant(P>0.05);Comparison to the norml group,the values of LVEDV,LVESV and SV determined by both methods in the AHCM group were decreased significantly(P<0.001),while there wasn’t statistical difference in LVEF between the two groups(P>0.05).(5)Comparison of repeatability: the values of ICC in Intra-observer repeatability of LVWT and left ventricular volume in patients with AHCMwere higher by LVO than that by 2DE.Conclusion:(1)LVO can improve the delineation of endocardial border,which could diagnose AHCM more accurately than 2DE.(2)LVO canimprove the display of left ventricular apical structure,which can more accurately evaluate the LVWT,left ventricular volume in patients with AHCM than by 2DE and can provide reliable information for clinical diagnosis and treatment.Part ⅡClinical study on the quantitative evaluation of myocardial perfusion in patients with apical hypertrophic cardiomyopathy by myocardial contrast echocardiographyObjective:To evaluate the clinical value of myocardial contrast echocardiography(MCE)on the quantitative evaluation of myocardial perfusion in patients with apical hypertrophic cardiomyopathy(AHCM).Methods:All the 27 patients with AHCM and 33 normal subjects underwent intravenous MCE after performed 2DE and LVO described as Part Ⅰ.MCE images of AP4C、AP2C、AP3C were acquired with triggered replenishment,and copied to Phillips QLAB 9.1workstation.The peak systolic longitudinal strain(LS)of each 16 left ventricular segments and globle longitudinal strain(GLS)were analyzed by software CMQ.The myocardial perfusion parameters were analyzed by software PQ using myocardial perfusion replenishment curve,myocardial perfusion parameters include A(A reflects the myocardial blood volume,MBF),the slope β(β reflects the myocardial blood velocity)and the product of Axβ(Axβreflects myocardial blood flow,MBF).The myocardial perfusion parameters,LS at the short axis of mitral level,papillary muscle level,apical level and GLS werecompared in the two groups.The correlations between the myocardial perfusion parameters and LVWT,LS were analyzed.Results:(1)Comparison of the perfusion parameters between the two groups: compared to the control group,the A values at the mitral level,papillary muscle level and apical level in the AHCM group were lower with statistical significance(P<0.001),while β values at all short axis levels in the AHCM group were higher significantly(P<0.05);The A*β values at the apical level in the AHCM group were significantly lower than that in the control group(P<0.001),while there were no statistical differences in the A*β values at the mitral level,papillary muscle level between the two groups(P>0.05).(2)Comparison of LS and GLS between the two groups:the values of LS at the papillary muscle level,apical level and the values of GLS in AHCM group were lower than that in the control group,the differences were significant(P<0.001);There was no statistical difference of LS at themitral level between the two groups(P>0.05).(3)Correlation analysis: in AHCM group,there were significant negative correlations between A,A*β and LVWT(P<0.001);while there was a significant positive correlation between β and LVWT(P<0.001);there were significant positive correlations between A,A*β and LS(P<0.001);there was a significant negative correlation between β and LS(P<0.001).Conclusion:(1)Myocardial microcirculation dysfunction may exist in the patients with AHCM.(2)The abnormal myocardial microcirculation is closely related to the increased LVWT in the patients with AHCM.(3)The dysfunction of myocardial microcirculation was closely related to the subclinical systolic dysfunction of left ventricle in the patients with AHCM.(4)MCE can quantitatively evaluate the myocardial perfusion in patients with AHCM,and provide a new imaging method and a new concerning field for the diagnosis and treatment of the disease. 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