Evaluation Of The Left Ventricular Functions In Patients With Coronary Heart Disease Before And After PCI Or CABG Using STI And RT-3DE

ObjectiveIt is important to correctly evaluate the cardiac functions in localization diagnosis,curative effect assessment, and prognostic evaluation before and after the myocardialrevascularization in patients with coronary heart disease. Intriguingly, a quantitativedescription of the ventricular systolic state before and after the surgery can achieve this aimand help to understand the pathological changes in the related cardiac muscles and theirimprovements. In this study, we employed the speckle tracking imaging (STI) and real-timethree-dimensional echocardiography (RT-3DE) to assess the changes of the regional andtotal left ventricular functions and the changes of the left ventricular wall motionsynchronism in different stages before and after percutaneous coronary intervention (PCI)or coronary artery by pass grafting (CABG).MethodsA total of65patients with coronary heart disease were included in the present study, ofwhich35received PCI in Department of Cardiology, Xinqiao Hospital (PCI group:21menand14women, average age56.1±12.5) and the others received CABG in Department ofCardial Surgery, Xinqiao Hospital (CABG group:19men and11women, average age57.8±14.8) between November,2010and October,2011.The patients receivedechocardiography and RT-3DE on3days before the surgery and1month,3months,6months after the surgery, collected a series of two-dimensional and Real-timethree-dimensional full-volume ultrasound images strain results of the left ventricle.48ageand gender matched healthy people were chosen as normal control group. After using STIto analyze the acquired two-dimensional strain echocardiographs, the conventional andtwo-dimensional strain parameters were compared among the PCI, CABG and controlgroups, and the correlations were analyzed with treatment stage in different treatment groups. After using Qlab8.1-3DQA to acquire the volume–time curve (VTC) of leftventricular segment17, the global three-dimensional parameters and the left ventricularsystolic dyssynchrony imaging(SDI) were calculated and compared before and after PCI orCABG. Their correlations with treatment stage were analyzed in different treatment groupsfurther. The left ventricular wall motion synchronism was also analyzed through combiningVTC and oculus bovis graph. In addition, the radionuclide myocardial perfusion emissioncomputerized tomography (ECT) was employed to acquire the left ventricular ejectionfraction (LVEF) before and after the surgery, and these data were compared with the valuesmeasured in RT-3DE or two-dimensional echocardiography (2DE)Results1．Evaluation of the left ventricular functions in patients with coronary heart diseasebefore and after PCI or CABG using STI（1）Several conventional and two-dimensional strain parameters including E/A, leftventricular ejection fraction (LVEF), LS, GBLS, RS, GBRS, CS, GBLS, Prot-endo apex,Prot-endo base, Prot-epi apex, Prot apex, Prot base, and Ptw were significantly lower ineither PCI group or CABG group before the surgery than in control group.（2）In PCI group, LS, RS, CS, Prot apex, Prot base, and Ptw improved after thesurgery and continually increased along with the time. Data in several segments evenreached the normal values after6months.（3）In CABG group, LS, RS, CS in several segments and Prot apex, Prot base, andPtw also improved after1month of the surgery, but were lower than the values in PCIgroup. These parameters also improved in3and6months later.（4）In PCI group, GBLS, GBRS, and GBCS improved after the surgery andcontinually increased along with the time, but all of them were significant lower than thecontrol group in6months later. There is no significant difference between various stages ofpostoperative and preoperative.（5）In PCI group, compared with control group and preoperative,the overallresponse parameters have significant difference in3and6months later,except in1month.（6）Both PCI and CABG groups, in1、3and6months later,the E/A of postoperativehas significant improvement than preoperative,and is Close to normal levels in6months later.（7）Both PCI and CABG groups, either GBLS, or GBRS, or GBCS were greatlycorrelated with LVEF.2．Evaluation of the left ventricular functions and wall motion synchronism in patientswith coronary heart disease before and after PCI or CABG using RT3DE（1） Several three-dimensional parameters including left ventricular end diastolicvolume (LVEDV), left ventricular end-systolic volume (LVESV), and stroke volume (SV),and SDI including Tmsv16-SD, Tmsv12-SD, Tmsv6-SD, Tmsv16-Dif, Tmsv12-Dif,Tmsv6-Dif, Tmsv16-SD%, Tmsv12-SD%, Tmsv6-SD%, Tmsv16-Dif%, Tmsv12-Dif%,and Tmsv6-Dif%were significantly higher than control group either PCI group or CABGgroup before the surgery. And the LVEF, left ventricular global peak ejection rate (GPER),and ventricular global peak filling rate(GPFR) were significantly lower than control group.（2） In PCI group, LVEDV, LVESV, and all SDI significantly decreased, but LVEF,GPER, and GPFR significantly increased after surgery in1、3and6months later. LVEDV,LVESV, SV, and GPFR even reached the normal values in6months later. Other parameterswere significantly different than those in normal group.（3） In CABG group, LVEDV, LVESV, SV, and SDI significant changed at3and6months later after the surgery. after1month later after the surgery, only GPER and GPFRchanged.（4） Compared with the data from RT-3DE and ECT, the LVEF values in the samegroup and in the same stage were not significant different. But in2DE, the measured LVEFvalues were higher than in the same group and in the same stage measured with RT-3DEand ECT.ConclusionsSTI could be used quantitatively assess the regional and total left ventricular systolicfunctions before and after PCI or CABG：More significantly reduced coronary heart diseasein patients with the systolic function of regional cardiac muscles and total left ventricularsystolic and diastolic functions before surgery than the normal control group. The vastmajority of coronary heart disease in patients with PCI or CABG，left ventricular cardiacfunction and Systolic function of ischemic myocardial segments have been significantly improved，tending to increase with postoperative time goes on；After the CABG, theimprovements of the left ventricle diastolic function and the systolic function of regionalcardiac muscles occurs earlier than the improvements of the systolic function of total leftventricle the cardiac rotation and torsion. Intriguingly, all the improvements for regionaland global left ventricular systolic functions, rotation, and torsion occur earlier and arebetter in PCI group than in CABG group.Our present RT-3DE could be used to quantitatively assess the changes of leftventricular systolic and diastolic function and the asynchronization of left ventricularmovement before and after PCI or CABG.It has important clinical value in evaluation thetreatment effectiveness and prognosis：In coronary heart disease patients, the left ventricularsystolic and diastolic function was significantly reduced and the left ventricular wallsystolic motion was not synchronized before surgery. The RT-3DE parameters of cardiacfunction parameters and left ventricular synchronization indicator had improvedsignificantly after PCI or CABG，tending to increase with postoperative time goes on.Thetotal left ventricular diastolic function improved early than the total systolic function afterCABG. The improvement of the left ventricular systolic movement synchronization and thetotal left ventricular function in time and degree in PCI group was early and better than inthe CABG group. There has better sensitivity in detecting left ventricular function changesin RT-3DE compared with traditional2DE technology.