The Clinical Analysis Of Viral Myocarditis And The Applied Research Of Echocardiography

Objective:By analysing and generalizing systematically the clinical features from the process of occurrence, development, diagnosis and treatment in patients with VMC in this study. Exploring the value of echocardiography in the diagnosis and treatment of VMC. So that a theoretical basis will be provide for the the early clinical diagnosis and assessment of treatment effect in patients with VMC.Methods:1. A retrospective analysis was used to count clinical data of78patients admitted to our hospital with VMC from January2007to December2012. Severe VMC was subsumed severe group that was divided into the death group and severe cure group according to the prognosis, the rest was subsumed non-severe group. VMC that was like myocardial infarction was considered as the observation group according to electrocardiogram and cardiac enzymes change, the rest was subsumed the control group. Detailed information collection included age, male to female ratio, first diagnosed symptoms, objective sign, results of laboratory examinations, treatment and outcome. The following check should be completed within24hours after admission, electrocardiogram, chest X-ray, myocardial enzymes, troponin I, blood routine examination and biochemistry. Kansas City Cardiomyopathy Questionnaire (see Appendix1) should be completed after following up cardiac symptoms of patients. the clinical features of the VMC was summarized through the above information.2. echocardiography not less than twice and Echocardiographic Multi-Parameter Score should be completed within24hours after admission. There were correlation analysis between EMPS of severe VMC and other clinical data. The significant factors after univariate analysis were analysed by applying Logistic regression to screen independent predictor of the severe VMC. Results:I. The average age of78patients with VMC, with mean age of (35.91±14.21) years, included the30cases severe VMC group and48cases non-severe group. age, gender, heart rate, systolic blood pressure, diastolic blood pressure in the severe group had significantly differences with non-severe group.70.51%of all patients had a clear history of viral infection, gasp, chest tightness, chest pain is the most common first diagnosed symptoms, Common complications included acute left ventricular failure and third degree A-V block. Cardiac markers had raised with different degrees. The raised degree of AST, LDH, TnI, white blood cell count, neutrophil count and high-sensitivity C-reactive protein in severe cure group was greater significantly than that in non-severe group. The electrokardiogram showed abnormal performance, the ST-T changes and arrhythmia were the most common. The raised degree of CK, LDH, Tnl, WBC、neutrophil count in VMC that was like myocardial infarction was greater significantly than that in the control group. The descended percentage of the left ventricular systolic function in severe cure group was higher than that in non-severe. The ventricular activation, left ventricular systolic function and valvular regurgitation had improved significantly after treatment. It was essential that rest in bed, oxygen inhale, electrocardiogram monitoring, oxyradical purge, Improving myocardial metabolism, Inhibition of ventricular remodeling, the necessary anti-heart failure, antiarrhythmic treatment that was symptomatic and sustentacular for all patients.72cases were cured or improved,6cases death,2cases were developed the dilated cardiomyopathy among all patients, average score of the Kansas City Cardiomyopathy Questionnaire in severe cure group was higher than that in non-severe.2. LVDd and LVEF were lower, IVS and LVPW were thick, EMPS was larger in severe group compared with non-severe group before treatment. LVDd was significantly increased in patients in severe group after treatment. Compared before treatment and after treatment, LVDs, IVS, LVPW, LVEF improved significantly in severe cure group, LVDs, LVEF improved significantly in non-severe group, The degree of improvement about LVDd, IVS, LVEF in severe cure group was greater than that in non-severe group. VMC that was like myocardial infarction compared with the control group, LVPW in the observation group was Greater before treatment, LVDd was Less after treatment than that in the control group. Compared before treatment and after treatment, LVDs, LVPW, LVEF improved significantly in the observation group, LVDs, IVS, LVEF improved significantly in in the control group. Multi-factor linear regression showed that TnI, hsCRP and age positively related to EMPS, LVEF negatively related to EMPS. Multivariate logistic regression analysis showed that gender, EMPS, TnI, heart rate, systolic blood pressure were independent predictors of severe VMC.Conclusions:1. The majority had prodromal symptoms of viral infection in Patients with VMC. The most common complications included acute left ventricular failure and third degree A-V block.2. Changes of cardiac markers and white blood cell count, neutrophil count, high-sensitivity C-reactive protein contribute to the diagnosis of VMC and antidiastole of the severe viral myocarditis.3. There were serious myocardial damage and inflammatory reaction in VMC that was like myocardial infarction. It was very important to observation ECG evolution. Coronary arteriography was a pivotal measure to antidiastole.4. The echocardiography and EMPS have an important value for assessing condition and treatment effect in VMC.5. EMPS, TnI, heart rate, systolic blood pressure are independent predictors of severe VMC.