ObjectiveThis study aimed to evaluate the myocardial mechanical characteristics in patients with Brugada syndrome （BrS） using multimodal echocardiography， to provide imaging evidence for the assessment of occult myocardial mechanical abnormalities in BrS. MethodsPatients diagnosed with BrS in Sun Yat-sen Memorial Hospital between January 2020 and December 2023 were enrolled. Speckle-tracking echocardiography （STE） was performed to measure left ventricular global longitudinal strain （LV-GLS）， right ventricular free wall longitudinal strain （RVFW-LS）， and right ventricular global longitudinal strain （RV-GLS）， as well as corresponding mechanical dispersion parameters （LV-MD， RVFW-MD， RV-MD）. Left and right ventricular myocardial performance indices （LV-MPI， RV-MPI） were calculated using tissue Doppler imaging （TDI）. ResultsAll five BrS patients had normal conventional ventricular systolic function， while marked individual differences were observed in multimodal echocardiographic parameters. Patients with high-risk phenotype， characterized by both spontaneous type 1 Brugada electrocardiogram and SCN5A gene mutation， exhibited elevated myocardial performance indexes （maximum LV-MPI 0.53， maximum RV-MPI 0.67） or increased mechanical dispersion （maximum LV-MD 61 ms）. ConclusionPatients with BrS present subclinical myocardial mechanical dysfunction undetectable by conventional echocardiography. Combined assessment of myocardial performance index and multi-parameter STE can identify subtle impairments in ventricular function and systolic synchronicity. Multimodal echocardiography has valuable potential for the assessment of subclinical myocardial injuries in BrS.

Perianal fistula is a predictor of long⁃term poor prognosis in patients with Crohn’s disease, and perianal fistulizing Crohn’s disease (pfCD) seriously affects the quality of life of patients. The treatment of pfCD advocates a combination of surgery and drug therapy. The advent of biologic agents, especially TNF⁃α agents, has greatly changed the prognosis of patients with pfCD. In recent years, some new biological agents and mesenchymal stem cells have also been shown to contribute to the remission of the disease. For complex perianal fistula, preservation of sphincter has greatly reduced postoperative complications such as urinary incontinence, bringing new hope to pfCD patients. This article reviewed the progress in research on the diagnosis and treatment of pfCD.