Clinical Study Of Left Ventricular Regional Systolic Function Using Real-time Three-dimensional Echocardiography Before And After Percutaneous Coronary Intervention

BackgroundMyocardium infarction (MI) is a severe complication of coronary heart disease (CHD). It has been proved that there is a close relationship between prognosis of MI and left ventricular systolic function. As an important therapy of CHD, it has been proved that the left ventricular (LV) systolic regional function is closed to the treatment effects of percutaneous coronary intervention (PCI).Left ventricular ejection fraction (LVEF) can sensitively reflect the changes in systolic function of left ventricle and the efficiency of pumping in left ventricle. The whole function of left ventricle is determined by the condition of contraction and movement of all segment of ventricular wall. When above 10% of the whole wall contracts abnormally, LVEF decreases. The two dimensional echocardiography (2-DE) have limitations in measurement of left ventricular systolic function after MI. As a new technique, real-time three-dimensional echocardiography (RT-3DE) is an ideal tool for the meas-urement of LV volume by geometry LV. For this reason, it can obtain accurate result in deformed or motion abnormal LV.ObjectiveTo explore the relationship between the change of systolic regional function and coronary artery supply blood regions using the technique of RT-3DE, and to evaluate the effects of PCI on LV systolic regional function in patients with CHD. To explore the clinical value of RT-3DE in assessment of LV systolic function before and after PCI.MethodsRT-3DE was performed in 24 normal subjects and 26 patients with myocardial infarction. The patients were divided into three groups according to coronary artery angiography:10 with left anterior descending (LAD) process, 8 with left circumflex (LCX) process, and 8 with right coronary artery (RCA) process. All patients with CHD, who had stenosis more than 75 percent in one vessel coronary artery underwent PCI. All patients and 24 health subjects were tested using RT-3DE by turns before and 3 months after PCI. In order to evaluate the relationship between abnormality of regional eject fraction (REF) and infarct related artery (IRA), seventeen segmental volume-time curve (VTC) and REF were obtained by Q-lab software.Results(1) The LVEF of AMI subjects decreased significantly compared with the normal subjects (P>0.05).(2) There were significant differences in REF before and after PCI (P<0.05).(3) The REF of MI segments decreased significantly compared with corresponding segments in the normal subjects, and the regional function of non-MI segments increased compensatively (P<0.05)(4).In 3 months after PCI, RT-3DE showed that the LVEF increased com-paring with the value of pre-operation (P<0.05)(5) With the improvement of the regional function of MI segments, the compensation of non-MI segments trend to normalization in REF after PCI (P>0.05).Conclusions(1) PCI can improve the regional and the whole function of LV, to some extent.(2) VTC parameter REF derived from RT-3DE can assess LV systolic function accurately.(3) The REF of infarct related segments is correlated significantly with the supply blood regions determined by IRA.(4) The compensatory compensation of non-MI segments trend normalize-tion in REF after PCI.