The Application Of Two-dimensional Speckle Tracking Echocardiography In Right Ventricular Function And Prognostic Predication In Coronary Artery Disease Patients With Left Heart Failure

Objective:To explore the value of two-dimensional speckle tracking echocardiography(2D-STE)in evaluating the right ventricular(RV)function of heart failure patients caused by coronary heart disease and its prognostic prediction,simultaneously,to analyze whether the 2D-STE can detect subtle impalement in RV function in patients with heart failure with different pulmonary artery pressures.Methods:103 heart failure patients caused by coronary heart disease were enrolled,and 26 healthy volunteers were also included in our study as the control group.Routine echocardiography,2D-STE analysis,and serological examination were performed in all individuals.SPSS software was used to compare the difference between the global longitudinal strain and free wall strain of RV between the two groups,and to compare the RV strain parameters between the disease groups with different left ventricular ejection fraction(LVEF)or different pulmonary artery pressures.According to the adverse events,make the ROC curves to determine the best cut-off value of RV strain parameters,and use these values to create the Kaplan-Meier curve to observe the prognosis of the patients under the cut-off value.Results:(1)The absolute value of RV strain indices were all decreased in both HF groups when compared with normal controls(all P<0.01),and were more severe in the HFrEF group(all P<0.01).(2)In both disease groups,,the absolute value of the right ventricular strain indices gradually decreased as the pulmonary artery pressure increased(all P<0.01);(3)Right ventricular free wall longitudinal strain(RVFWLS)and right ventricular four-chamber longitudinal strain(RV4CLS)in the heart failure group and the normal control group were correlated with LVEF and the conventional indicators of right ventricular function including fractional area change(FAC)and tricuspid annular plane systolic excursion(TAPSE)(r＝0.89、0.68、0.56;r=0.83、0.65、0.52,all P<0.01)(4)In terms of prognostic predication,the AUC of RVFWLS and RV4CLS were 0.78(95%CI:0.68-0.88)and 0.8(95%CI:0.7-0.90)respectively,with the absolute value of cut-off value of 15.72%in RVFWLS and 14.15%in RV4CLS.Kaplan-Meier curve showed that in the incidence of adverse events among patients with coronary artery disease and left heart failure whose RVFWLS and RV4CLS under the absolute value of cut-off value was significantly higher than that of patients whose RVFWLS and RV4CLS were above the absolute value of cut-off value(all P<0.01).Conclusion:(1)Great correlations between the strain parameters derived from 2D-STE and the conventional echocardiographic parameters for assessment of RV function were observed in this study;(2)The strain parameters derived from 2D-STE are significantly decreased in heart failure patients induced by coronary artery disease.(3)The absolute values of the right ventricular longitudinal strain parameters were decreased in patients with different phenotypes of heart failure and it decreased with the aggravation of left ventricular myocardial damage;(4)The right heart function of patients with coronary artery disease and left heart failure decreases with the increase of pulmonary artery pressure,and the technique 2D-STE can reflect this change;(5)The right ventricular strain indices can help clinicians identify high-risk patients with heart failure.