Objective To evaluate the left ventricular systolic function of patients with fulminant myocarditis and myocardial infarction during veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy using bedside transthoracic echocardiography, so as to explore the application value of bedside echocardiography during VA-ECMO therapy. Methods A retrospective analysis was carried out on 32 patients undergoing VA-ECMO support in our hospital. Sixteen patients with cardiogenic shock and successful weaning were selected and divided into two groups: the fulminant myocarditis group (n=8) and the myocardial infarction group (n=8). Further inter-group and intra-group comparisons were performed on the general clinical data, left atrial diameter (LAD), left ventricular end-diastolic diameter (LVDD), and left ventricular ejection fraction (LVEF) before VA-ECMO support, 24 hours after VA-ECMO support, and after the successful weaning, respectively. Results (1) Comparison of general clinical data: The average age of the fulminant myocarditis group was smaller than that of the myocardial infarction group [(34.2±9.0) vs. (64.1±6.9) years]. (2) Comparison within groups: The average level of LVDD before VA-ECMO support establishment in explosive myocarditis group was lower than that after 24h (46.7±8.8) mm. The average level of LVEF after successful weaning was higher than that 24 hours after VA-ECMO support [ (51.5±21.3) % vs. (33.9±18.4) %]. Furthermore, in the myocardial infarction group, there were no significant differences in LAD, LVDD and LVEF before VA-ECMO support was established, 24h after VA-ECMO support was established, and after successful withdrawal. (3) Comparison between the two groups: The LAD in explosive myocarditis group was lower than that in acute myocardial infarction group before VA-ECMO support was established, 24h after VA-ECMO support was established and after successful withdrawal. The average LVDD level of the myocardial infarction group was higher than that of the fulminant myocarditis group before VA-ECMO support. Besides, The LVEF of explosive myocarditis group was higher than that of acute myocardial infarction group. Conclusions VA-ECMO support can significantly improve LVEF in patients with myocarditis and the impact of fulminant myocarditis on cardiac function is possibly reversible. VA-ECMO support did not significantly improve LAD, LVDD and LVEF in myocardial infarction group, but could buy a period of time for other purposes of treatment. LAD in explosive myocarditis group was lower than that in acute myocardial infarction group before VA-ECMO support was established, 24h after VA-ECMO support was established, and before ICU transfer after successful withdrawal . Age, LAD and LVDD may affect the recovery of cardiac function.
Key words
VA-ECMO /
echocardiography /
left ventricular function /
fulminant myocarditis /
myocardial infarction
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