Evaluation Of Myocardial Perfusion And Systolic Function In Patients With Coronary Artery Disease By Myocardial Contrast Echocardiography And Two-dimensional Strain Echocardiography

Evaluation of myocardial perfusion and systolic function in patients with coronary artery disease by myocardial contrast echocardiography and two-dimensional strain echocardiographyPART I Evaluation of the impact of the degree of coronary artery stenosis on myocardial perfusion by real-time myocardial contrast echocardiographyObjective We attempted to evaluate the impact of the degree of coronary artery stenosis of coronary artery patients on myocardial perfusion by real-time myocardial contrast echocardiography (MCE).Methods 40 patients underwent intravenous real-time MCE after venous injections of Sono Vue. Left ventricular wall was divided into 18 segments and quantitative analysis was performed by Q-analysis software.Results (1) There were 507 segments subtended by coronary arteries with >50% stenosis, including 114 segments with abnormal wall motion and 393 segments without abnormal wall motion. A, k and the product A×k were significantly lower in segments with abnormal wall motion than those without abnormal wall motion [(6.07±3.16) dB vs (7.20±3.11) dB, P< 0.01; (0.25±0.11)/s vs (0.31±0.16)/s,P<0.01; (1.57±1.25)dB/s vs (2.28±1.16) dB/s, P<0.01==. However, the standardized number of the product A×k was significantly lower in segments with abnormal wall motion than those without abnormal wall motion [(0.13±0.10) vs (0.19±0.16), P<0.01=. (2) Segments with normal wall motion were divided into 2 groups. Group 1 had 279 segments whose flow was subtended by coronary arteries with≥75% stenosis. Group 2 had 114 segments whose flow was subtended by coronary arteries with <75% stenosis. The product A×k in group 1 was lower than that in group 2[(2.14±1.46) dB/s vs (2.62±2.02) dB/s, P<0.01]. At the same time, the standardized number of the product A×k in group 1 was lower than that in group 2[(0.17±0.11) vs (0.23±0.15), P< 0.05=.Conclusions Our present study showed that the product A×k in segments with abnormal wall motion in patients was significantly different from that in segments without abnormal wall motion. The product A×k in segments without abnormal wall motion was related with coronary artery stenosis.PARTⅡEvaluation of real-time myocardial contrast echocardiography and Two-dimensional strain echocardiography on viable myocardium in patients with myocardial infarctionObjective We attempted to evaluate myocardial viability in patients with myocardial infarction with intravenous real-time myocardial contrast echocardiography (RT-MCE) and Two-dimensional strain echocardiography.Methods Intravenous RT-MCE was performed in 20 patients with myocardial infarction before revascularization. Myocardial perfusion was assessed by visual interpretation and divided into 3 conditions:contrast defect=3; partial or reduced opacification or subendocardial contrast defect=2; homogeneous opacification=1, presence of viability was defined as the presence of contrast effect (score≤2). Two-dimensional images were recorded from the left ventricular four-chamber view, two-chamber view and the apical view before and after revascularization, according ventricular wall motion improved after revascularization, which were divided into viable myocardium group and non-viable myocardium group, the peak systolic longitudinal strain was measured in the apical views before operation.Results (1) 90 significantly segmental wall motion abnormality were found by two-dimensional echocardiography before revascularization, including 70 of abnormal segmental wall motion improved post-operation. (2) Viable myocardium group had 65 segments and non-viable myocardium group had 25 segments detected by RT-MCE before revascularization. The sensitivity, specificity and accuracy were 93.8%,64% and 85.5% respectively. (3) The peak systolic longitudinal strain of viable myocardium group were significantly higher than non-viable myocardium group[(-7.34±5.84)% vs (-2.11±1.66)%, p <0.001]. When taking peak systolic longitudinal strain≤-5.0% as a cut-off value for detecting survived myocardium, the sensitivity and specificity were 72% and 85% respectively.Conclusions RT-MCE can accurately assess myocardial viability. At the same time, when taking peak systolic longitudinal strain≤-5.0% as cut-off value can also assess myocardial viability. PART III Assessment of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery by real-time myocardial contrast echocardiography and two-dimensional strain echocardiographyObjective To assess the clinical application value of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery using real-time myocardial contrast echocardiography (RT-MCE) combined with two-dimensional strain echocardiography.Methods 20 patients underwent intravenous RT-MCE by venous injections of Sono Vue before and after coronary artery bypass surgery. Two-dimensional images were recorded from the left ventricular four-chamber view, two-chamber view and the apical view before and after two weeks and three months coronary artery bypass surgery, the peak systolic longitudinal strain was measured.Results Myocardial perfusion significantly increased after coronary artery bypass surgery in about 71.6% segments. In the group that myocardial perfusion was improved, the peak systolic longitudinal strain after three months bypass surgery was significantly higher than that before operation [(-15.78±5.91)% vs. (-10.45±8.31)%, P<0.05]. However, the parameters did not change in the group without myocardial perfusion improvement [(-10.33±6.53)% vs. (-9.41±6.09)%, P>0.05].Conclusions Whether or not the improvement of myocardial perfusion can reflect the recovery trend of regional systolic function, and two-dimensional strain echocardiography can observe dynamic change of regional systolic function, combined with the two methods can more accurately assess the treatment results of coronary artery bypass surgery.