Application Of Two-Dimensional Speckle Tracking Technique In Assessing Left Ventricular Diastolic Dysfunction

Objective:In this study,the left ventricular and left atrial total strain rate and the ratio of E/mGS were compared with Cardiac catheter left ventricular diastolic function index in patients with diastolic heart failure by two-dimensional speckle tracking imaging(2D-STI)to evaluate the value of left ventricular diastolic dysfunction in patients with diastolic heart failure.It is to provide a certain reference value for the clinical evaluation of diastolic heart failure.Methods:1 Object: Select patients from July 2015 to December 2016 in Hebei Medical University Hospital Second Hospital.The left ventricular end diastolic pressure was measured by cardiac catheterization Department of Cardiology,and do heart ultrasound within 24 hours before or during the operation.Including 25 males and 23 females,age from55 to 65.Except for severe Heart valve disease(eg,severe mitral regurgitation,severe mitral valve prolapse and history of mitral valve surgery),myocardial infarction,arrhythmia(atrial fibrillation,Atrioventricular block),ultrasound image quality Poor,patient with pacemaker installation.Patients were divided into LVEDP increased(>16mmHg)group(n=25)and LVEDP normal(≤16 mmHg)group(n=23).2 Method: The parameters of the left ventricular structure(LAD,IVST,LVPWT,LVDd)were measured by transthoracic echocardiography.The other parameters were Left heart function related indicators: LVEF,DT,IVRT,IVST,E,A,E / A;(LAV max),left atrial minimum volume(LAV min),which measured by Simpson method,and left atrial fraction(LAEF)based on left atrial volume,and left atrial volume index(LAVI);Tissue Doppler technique was used to measure the left ventricular function index: Ea,Aa,Ea/Aa,E/Ea;Evaluation of Cardiac Exercise MPI Index:(a-b)/b;myocardial systolic strain rate(SRs),early myocardial strain(SRe),myocardial diastolic late strain rate(SRa)were measured by two-dimensional spot tracking technique.And calculate the mean value of SRs,SRe,SRa and GS,they were mSRs and mSRe and mSRa and mGS.Compared the left ventricular and left atrial strain,strain rate,and analyze the correlation between the "gold index" of left ventricular diastolic function in the left and right diastolic blood pressure(LVEDP).3 Statistical analysis: Creating a database through the application of SPSS 19.0 software package for statistical analysis.normal distribution:measurement data were expressed as mean ± standard deviation(x ±s),the intergroup difference was compared with the independent sample t-test,correlation analysis by Pearson correlation coefficient.Non-normal distribution: the intergroup difference was compared with the independent samples nonparametric test,correlation analysis by Spearman correlation coefficient.P-value <0.05 was considered statistically signification.Results:1 A total of 48 patients,of which left ventricular end-diastolic group was25 cases,Left ventricular diastolic blood pressure in the normal group of 23cases;2 There was no significant difference in age,sex between the two groups(P> 0.05);3 Compared with the left ventricular diastolic and normal group,LVEDd,A peak velocity,E wave deceleration time(DT),LVEF(P>0.05)was not statistically significant;LAD,LAVI,IVSD,E(P<0.05)were statistically significant;4 Ea,E/Ea(6.626±1.43cm/s versus 5.616±1.31cm/s,P<0.05),(11.10±3.45,P<0.05 versus 8.39±1.65)were statistically significant,but there was no significant difference between E/A(P> 0.05);5 Compared with the normal group,the ratio of mSRs,mSRe and mGS to E/mGS in left atrium were(2.21±0.64S-1 versus 1.96±0.37S-1,P<0.05),(-2.35±0.72S-1 versus-2.16±0.83 S-1,P<0.05),(45.80±10.48% versus 40.66±8.19%,P<0.05),(1.44±0.40 versus 11.92±0.62,P<0.05),they were statistically significant Indicating that the longitudinal left ventricular systolic function,left atrial reserve function,left atrial duct function were decreased than the normal group6 Compared with the normal group,the E/mGS of the left ventricle increased(-3.08±0.70 versus-3.91±1.34,P<0.05),which was statistically significant,indicating that the longitudinal function of the left ventricle was impaired;7 The linear correlation analysis showed that E/Ea was positively correlated with LVEDP(r=0.54,P<0.05).IVSD,PWT and LAV were positively correlated with LVEDP(r=0.23,0.31 and 0.52,P<0.05).The left ventricular E/mGS was negatively correlated with LVEDP(r=0.47;P= 0.000);LAVI and E/A were a certain correlation(r=0.81,P<0.01).This study confirms that E/E’,LAVI,left ventricular and left atrial E/mGS ratios predict the ratio of left ventricular filling pressure,E and spot tracking techniques to measure the early longitudinal strain rate of left major axis(E/mGS)Was a noninvasive alternative to the increase in left ventricular filling pressure,and left atrial E/mGS showed a better correlation with LVEDP and had a reference value for evaluation of left ventricular diastolic function;8 E/mGS had good correlation with E/mGS(LV),E/mGS(LA),and the correlation coefficients were(r =0.85,P =0.000),(r =0.73,P =0.000);9 The left ventricular and left atrial strain,E/Ea and LAVI were used to identify the value of left ventricular end diastolic pressure.The ROC curve was established and E/mGS(LA)was used as the critical point of diastolic dysfunction.The area under the curve is about 0.712,the sensitivity is 76%,and the specificity is 61%.E/mGS(LV)was used as the critical point of diastolic dysfunction.The area under the curve was about 0.68,the sensitivity was 95.7% and the specificity was 48.0%.E/Ea was used as the critical point of diastolic dysfunction,the area under the curve was about 0.76,the sensitivity was 80.0% and the specificity was72.9%.Conclusions:1 The ratio of early mitral diastolic peak velocity to left atrial and left ventricular holistic strain rate(E/mGS)was positively correlated with LVEDP,they have a higher sensitivity to diastolic function changes and can assess the degree of damage,in order to provide new ideas for diastolic dysfunction in the classification and treatment.2 left atrial and left ventricular E/mGS ratio has a good correlation with E/ Ea,and the E/mGS ratio can be used as supplementary indicators to E/Ea.