Clinical Application Of Ultrasonic Noninvasive Myocardial Work Detection Technology In Evaluating Left Ventricular Systolic Function Before And After PCI In Patients With Coronary Artery Disease

Objective:To investigate the value of noninvasive myocardial work(MW)in quantitative evaluation of left ventricular systolic function before and after percutaneous coronary intervention(PCI)in patients with coronary artery disease(CAD).Methods:35 patients with CAD undergoing PCI were chosen as the case group,and 25 healthy volunteers in the same period were chosen as the control group.Left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left atrial diameter(LAD)and left ventricular ejection fraction(LVEF)were measured by conventional echocardiography.GE Echo PAC software was used to obtain myocardial work parameters included global work index(GWI),global constructive work(GCW),global wasted work(GWW),global work efficiency(GWE).In addition,global longitudinal strain(GLS)and peak strain time dispersion(PSD)were detected.The differences in myocardial work index between the two groups,including controls,patients before operation,1 week,1 month and 3 months after operation were compared.And the case group was compared in each time period.The correlation between parameters were analyzed.10 cases were randomly selected from the case group and the control group,and the consistency of the parameters was tested by Bland-Altman analysis.Results:1.Comparison of conventional ultrasonic parameters: compared with the control group,LAD,LVEDD and LVESD were significantly increased in each case groups,while LVEF was decreased(P<0.05).Compared with the preoperation and the postoperation 1-week,LAD,LVEDD and LVESD of the postoperation 1-month and3-month were decreased,while LVEF was increased(P<0.05).2.Comparison of left ventricular GLS and the myocardial work parameters:(1)Compared with the control group,GWI,GCW and GWE in each case groups were decreased before and after PCI,while GLS,GWW and PSD increased significantly(all P<0.05).(2)Compared with the preoperation,GWW and PSD of the postoperation1-week were decreased and GWE increased significantly(all P<0.05);GWI,GCW and GWE of the postoperation 1-month and 3-month were increased,while GLS,GWW and PSD were decreased(all P<0.05).(3)Compared with the postoperation 1-week,GWI,GCW and GWE were increased of the postoperation 1-month and 3-month,while GLS,GWW and PSD were decreased(all P<0.05).(4)Compared with the postoperation 1-month,GWI,GCW and GWE were increased of the postoperation 3-month,while GLS,GWW and PSD were decreased(all P<0.05).3.Analysis of Person correlation coefficient showed that there was a positive correlation between GWI,GCW,GWE and LVEF(r=0.358,0.381,0.338;all P<0.05),and a negative correlation between GWW and LVEF(r=-0.480;P<0.05).There was a negative correlation between GWI,GCW,GWE and GLS(r=-0.480,-0.492,-0.383;all P<0.05),and a positive correlation between GWW and GLS(r=0.505;P<0.05),and the correlation coefficients were greater than LVEF.GWE was negatively correlated with PSD(r=-0.339;P<0.05),and GWW was positively correlated with PSD(r=0.391;P<0.05).4.Consistency test: Bland-Altman analysis showed that the measurements of GWI,GCW,GWW and GWE between the observers and within the same observer exhibited good reproducibility.Conclusion:1.The myocardial work index of CAD patients decreased before PCI,increased after PCI,and showed an upward trend over time.Therefore,ultrasound non-invasive myocardial work technology can quantitatively evaluate the changes of left ventricular systolic function in patients with CAD before and after PCI.2.The indicators obtained by ultrasound non-invasive myocardial work technology have a good correlation with LVEF and GLS,and the latter is the guideline-recommended index for evaluating left ventricular systolic function.Therefore,myocardial work parameters can achieve non-invasive and accurate evaluation of left ventricular systolic function.3.The indicators obtained by the ultrasound non-invasive myocardial work technology have good consistency,they are helpful to evaluate the intervention mode of coronary heart disease.At the same time,the data is used to visually display the clinical efficacy,which is expected to be widely used in clinical work.