Evaluation Of The Whole And Regional Left Ventricular Systolic Function And Synchrony In Patients With Coronary Heart Disease Using RT-3DE And2D-STI

BACKGROUND AND OBJECTIVEWith the economic development and lifestyle changes, the incidenceand mortality rate of coronary heart disease(CHD) is increasing. CHD is aserious threat to human health and life. Patients with CHD have thecoronary artery stenosis or spasm, which lead to myocardial ischemia,myocardial systolic and diastolic function changed. Segmental wall motionabnormalities or even ventricular aneurysm are found in serious patientsusing2D echocardiography. Early diagnosis and treatment of CHDobviously improve the prognosis of patients. Coronary arteriography is thegold standard diagnosis of CHD, it can clear the narrow parts, the degree,the range, etc. But the technology is expensive and invasive, it maybe hassome risk. Echocardiography has been widely used in clinical diagnosis ofheart disease with the advantages of non-invasive, simple, cheap,repeatable. In recent years, RT-3DE and2D-STI overcometwo-dimensional image and doppler angle dependence. My study willassess the clinical value of RT-3DE and2D-STI in evaluating leftventricular systolic function and synchrony in patients with CHD, and investigate the correlation of two techniques. Then my study will evaluatethe whole and regional left ventricular systolic function and synchrony inpatients treated with percutaneous transluminal coronary intervention (PCI)on left anterior descending branch using RT-3DE.METHODS1. The application of RT-3DE and2D-STI in assessing LV systolic functionand synchrony in patients with CHD, and investigating the correlation oftwo techniques55patients were divided into three groups according to the differentresults of coronary arteriography.2D-STI and RT-3DE were performed onthe55patients and25healthy subjects.2D dynamic images were recordedat the left ventricular long and short-axis view. The peak systoliclongitudinal strain (LS), radial strain (RS), circumferential strain(CS) wereobtained. LV dyssynchrony was defined as an interval≥130ms for theabsolute difference in time to peak radial strain for the anteroseptal wallversus the posterior wall (TAS-POST)．3D dynamic images were recorded.The17-segmental time-volumetric curves were analyzed. The systolicfunction parameters(EDV, ESV, EF)and synchronic parameters (Tmsv16-SD％) were obtained. The Tmsv16-SD％was served as the systolicdyssynchrony index(SDI). The correlation of Tmsv-16-SD%and TAS-POST was analyzed.2. The application of RT-3DE in assessing the whole and regional leftventricular systolic function and synchrony in patients treated with PCI onleft anterior descending branchRT-3DE was performed on30patients treated with PCI on left anteriordescending branch in different time, including preoperative, postoperativeof one week, postoperative of one month and three months. The17-segmental time-volumetric curves were analyzed. The global systolicfunction parameters(EDV, ESV, EF)and synchronic parameters (Tmsv16-SD％) were obtained. The Tmsv16-SD％was served as the systolicdyssynchrony index(SDI). Regional systolic function parameters(rEDV,rESV, rEF) and synchronic parameters(Tmsv%) were obtained.RESULTS1. The application of RT-3DE and2D-STI in assessing LV systolic functionand synchrony in patients with CHD, and investigating the correlation oftwo techniquesCompared with control group, parameters of study groups weresignificant different（P<0.05）. EDV, ESV, Tmsv-16-SD%and TAS-POSTwere significantly larger. EF, CS, RS and LS were significantly smaller.Among the study groups, EDV, ESV and TAS-POST were higher in themulti-branch stenosis group compared with groups of LCA and RCA （P<0.05）, LS and Tmsv-16-SD%were significant different with RCAgroup（P<0.05）. Between groups of LCA and RCA, LS and Tmsv-16-SD%were significant different（P<0.05）. Tmsv-16-SD%and TAS-POST havepositive correlation (r=0.794，P<0.001).2. The application of RT-3DE in assessing the whole and regional leftventricular systolic function and synchrony in patients treated with PCI onleft anterior descending branchCompared with preperative and postoperative of one week, the globalEDV and ESV, regional rESV and rEDV of most segments in postoperativeof one month group were decreased（P<0.05）, while the EF and rEF wereincreased（P<0.05）. Tmsv-16-SD%and Tmsv%of some segments weredecreased compared with preperative （P<0.05）, while there were nosignificantly difference compared with postoperative of one week（P>0.05）．Compared with preperative, postoperative of one week andpostoperative of one month, the global ESV, Tmsv-16-SD%and rEDV,rESV, Tmsv%of most segments in postoperative of three months groupwere decreased（P<0.05）,while the EF and rEF of most segments wereincreased（P<0.05）. The EDV was decreased compared with preperativeand postoperative of one week（P<0.05）, while there were no significantlydifference compared with postoperative of one month（P>0.05）.CONCLUSION1. RT-3DE and2D-STI can provide a useful method in assessing LV systolic function and synchrony in patients with coronary heart disease ofdifferent coronary artery branch stenosis. There are various degree ofcorrelations of RT-3DE and2D-STI between some parameters.2. RT-3DE can provide a useful method in assessing the whole and regionalleft ventricular systolic function and synchrony in patients treated with PCIon left anterior descending branch.