| Purpose:Percutaneous coronary intervention (PCI) is a major method to cure the coronary heart disease. The assessment of the cardiac muscle perfusion situation after coronary intervention therapy is key to estimate the success of the operation and curative effect afterwards. At present, the methods to assess the cardiac muscle perfusion are as follows:MRI, nuclide cardiac muscle perfusion imaging, ECG, Echocardiography and etc. Echocardiography is clinically widely used because it is easy to use, non-invasive, and can be repeated used. The conventional Echocardiography is mainly applied to LVEF (left ventricular ejection fraction) and wall motion abnormity Semi-quantitative analysis method, to indirectly reflect the cardiac muscle perfusion after the PCI operation. The measuring results are inaccurate and unstable due to subjective factors. In recent years, new indicators such as myocardial strain, myocardial strain rate and left ventricular torsion are used to make precise quantitative analysis of the partial and overall functional change. Now the major measuring method of myocardial strain, myocardial strain rate is Tissue Doppler imaging (TDI), which is used to measure the cardiac muscle motion along the long axis paralleling the acoustic beam. The advanced two-dimensional speckle tracking imaging (2DSTI), can measure the myocardial function of the coronary heart disease from the vertical angle, the radial angle circle strain and multi-directions. Through the application of STI to quantitively analyze the myocardial function before and a week after the operation, undirected indicator of myocardial perfusion and indirect indicator of myocardial perfusion this paper discusses the value of the 2DSTI in the diagnosis of the coronary heart disease and operation of the PCI.Method:50 coronary heart disease patients are selected for PCI operation and divided into two groups:group a without myocardial infarction and group b with myocardial infarction. Group includes 30 patients with 16 men and 14 women, aging from 44 to 67 and averaging 55.9±6.1 years old. Group b includes 20 patients with 12 men and 8 women, aging from 47 to 69 and averaging 53.6±5.6 years old. All patients'coronary artery are proved by SCA (selected coronary angiography) to be narrowed or clogged by 70% and have received PCI. Other serious diseases such as serious cardiac arrhythmia, Conduction abnormality, severe valvular disease and chronic obstructive pulmonary disease are ruled out. The comparison group includes 25 healthy volunteers with 15men and 10 women, aging from 40 to 50, averaging 53.0±7.7 years old. All of them are ruled out heart disease though medical history, physical examination, ECG, chest X-ray and Echocardiogram examinations. All participants are recorded the left ventricle short axis (mitral valve, papillary muscle, Apical level) imaging before and a week after the operation to measure the parameter change of STI. Apply simplified Simpson meathead to measure LEVF selecting standard apical four-chamber view and two-chamber view. STI measurement indicators included:①peak strain rate in systole (PSSR);②peak strain rate in early diastole (PESR);③peak strain in systole (PSS);⑤peak fractional shortening;⑥peak left ventricular rotation angle in systole;⑦calculation of left ventricular torsion angle.Results1. Normal strain-time curves showed a positive systolic wave, systolic strain rate-time curves showed a positive wave, early diastolic wave was positive, fractional shortening time curve was positive systolic wave, PSS, PSSR, RFS is positive, indicating myocardial systolic thickening, PESR is negative, indicating myocardial diastolic thinning. Short axis view at the same level between different segments, the same comparison between different parts of segments, PSS, PSSR, and RFS was no significant difference.2. Non-myocardial infarction abnormal myocardial segments of the PSS, PSSR, and RFS lower than the normal group.7 days after PCI, abnormal myocardial segments of the corresponding parameters were significantly increased. Reperfusion before the ischemia group at the base, apex Protation normal group, Ptwist reduced. After 7 days Protation,Ptwist significantly increased compared with preoperative.3. Myocardial infarction myocardial segments PSS, PSSR, RFS was significantly lower.7 days after PCI, part of the myocardial segments of the corresponding parameter value increased. Reperfusion before the ischemia group at the base, apex Protation normal group, Ptwist reduced. After 7 days Protation,Ptwist increased than that before operation.4.30 cases of non-myocardial infarction ventricular wall segments were 540, PCI was judged by visual assessment of preoperative wall motion abnormalities was 38 the number of cases, the detection rate with 0.07%; STI 270 were detected abnormal wall section, the detection rate of 50%, STI was significantly higher than the sensitivity of visual methods. Myocardial infarction, PCI improve clinical symptoms in 18 cases, by semi-quantitative analysis of visual wall motion improvements for the seven cases, Simpson method for the measurement of EF values improved in 10 cases, STI analysis of PSS, PSSR, RFS increased by 15 cases, the sensitivity was 38.9%,55.6%,83.3%, the sensitivity of STI was significantly higher than the other two methods (P<0.05)Conclusion1. PSS, PSSR, PESR, RFS as a sensitive indicator of myocardial ischemia, can determine a more accurate quantification of coronary artery disease in patients with abnormal myocardial segments movement in order to evaluate the local and overall coronary heart disease myocardial function. Left ventricular torsion is room for movement form myocardium in left ventricular systolic and diastolic movements play an important role.2. Conventional echocardiography and assessment of LVEF values can not be sensitive to PCI local and the overall early postoperative changes in cardiac function, but 2DSTI can measure the abnormal segments of the PSS, PSSR, PESR, RFS, and left ventricular torsion angle parameters, sensitive to determine myocardium and changes in overall cardiac function, and thus a more accurate quantitative analysis of myocardial perfusion after PCI, PCI operation on the evaluation of efficacy has important application value.
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