Study On Evaluation Of The Carotid Elasticity In Patients With Coronary Heart Disease With Two-dimensional Strain Imaging

Objective:To evaluate the carotid elasticity in patients with coronary heart disease (CHD) using two-dimensional strain imaing, explore the relationship of the carotid elasticity and CHD and the clinical application value of carotid elasticity in evaluating CHD.Methods:Two hundred and six hospitaized patients with suspected CHD who were to undergo coronary angiography were enrolled in the research, excluding hepatic and renal insufficiency, immunological diseases, arrhythmia such as frequently atrial premature and/or ventricular premature, atrial fibrillation, etal, severe heart failure, tumor, pulmonary heart disease and ultrasonic images of poor quality. According to the coronary angiography, the patients were divided into one diseased branch group inculding sixty-three cases, multiple diseased branches group including one hundred and three cases and non-CHD group including thirty cases. Recording the general conditions including age, sex, history of hypertension, smoking, etal, measuring brachial artery systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), testing laboratory parameters including the levels of uric acid (SUA), total serum bilirubin (TB), direct bilirubin (DB), indirect bilirubin (IB), fasting blood glucose (FBG), triacylglycerol (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), very low density lipoprotein cholesterol (VLDL-C), high density lipoprotein cholesterol (HDL-C), etal.All patients were examined by regularly ultrasonic cardiography to measure heart function parameters including left ventricular ejection fraction (LVEF), mitral valve blood flow E/A ratio (E/A), etal, and carotid artery ultrasonic testing to record parameters including carotid intima-media thickness (IMT), carotid artery systolic diameter (Ds), carotid artery diastolic diameter (Dd), the peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI), resistance index (RI), etal. Caculating the carotid elasticity indexes such as wall motion degrees (△D), stiffness coefficient (β1), pressure strain elastic coefficient (Ep), artery compliance (AC), etal. The systolic peak global circumferential strain (CS), early systolic global circumferential strain rate (SCr) and late systolic global circumferential strain rate (SCr) were obtained in short axis views using2D strain imaging, caculating stiffness coefficient (β2). All clincal datas were statistically analyzed and processed.Results:1. The plaque incidence in multiple diseased branches group (43.4%) was greater obviously than that in one diseased branch group (17.5%) and that in non-CHD group (20.0%), the carotid IMT, Ep and β1in CHD group were greater obviously than those in non-CHD group, while△D were lower obviously than those in non-CHD group (P＜0.05).2. The systolic peak global CS and early systolic global CSr in multiple diseased branches group were lower than those in one diseased branch group and those in non-CHD group (p<0.01), while the late systolic global CSr and β2in multiple diseased branches group were greater than those in one diseased branch group and those in non-CHD group (p<0.01), the systolic peak global CS and early systolic global CSr in one diseased branch group were lower than those in non-CHD group(P<0.01), while the late systolic global CSr and β2in one diseased branch group were greater than those in non-CHD group (p<0.01).3. The carotid IMT. β2and the late systolic global CSr positively related with Gensini score, r were0.277,0.466and0.454respectively (p<0.01), the systolic peak global CS and early systolic global CSr negatively related with Gensini score, r were-0.583and-0.502respectively (p＜0.01).4. In the correlation analysis of carotid elastic parameters, β2was positvely obviously related with β1, Ep and the late systolic global CSr, r were0.409,0.366and0.490respectively (p<0.01), and negatively obviously related with AC, the systolic peak global CS and early systolic global CSr, r were-0.303,-0.762and-0.566respectively (p<0.01).5. The LVEF in multiple diseased branches group was lower than that in one diseased branch group and non-CHD group, and the LVEF was negatively related with β2(r=-0.222, p<0.01), while positvely related with the systolic peak global CS (r=0.214,p＜0.01), the E/A decreased gradually with the presence of CHD and increase of lesion numbers, and the E/A was negatively related with β2and Ep, r were-0.189(p＜0.01) and-0.168(p<0.05), and positively related with the systolic peak global CS (r=0.195, p<0.01).6. The ROC curve analysis indicated that the under-curve areas of the systolic peak global CS, the early systolic global CSr, the late systolic global CSr and β2were86.9%,82.7%,80.3%and91.4%respectively, all of them showed high diagnostic value to CHD (p＜0.001).7. The discriminant function "Y=0.817*β2+0.500IMT-0.185plaque (1or0)"was obtained by discriminant ananlysis and its sensitivity and specificity of diagnosis of CHD were78.4%and93.3%respectively, the wholly accuracy rate was80.6%.Conclusion:1. The plaque incidence, the carotid IMT, Ep and β1were greater in CHD patients, while AC and△D were lower in CHD patients, which suggested the carotid structural and functional changes in CHD were obvious.2. With the presence of CHD and deterioration of lesion degrees, the systolic peak global CS and the early systolic global CSr decreased gradually, while the late systolic golbal CSr and β2increased gradually, which suggested the carotid elasticity decaresed and the stiffness increased with deterioration of lesion degrees in CHD patients.3. The carotid IMT, β2and the late systolic golbal CSr were positively while the systolic peak global CS and the early systolic global CSr were negatively related with Gensini score, which suggested that the above parameters may be good indexs to evaluate the severity of CHD.4. In CHD patients, the heart systolic function and diastolic function were closely realted with the carotid elasticity.5. The ROC curve analysis indicated that the systolic peak global CS, the early systolic global CSr, the late systolic global CSr and β2had high diagnostic value to CHD.6. Discriminant function "Y=0.817*β2+0.500IMT-0.185plaque (1or0)" can further improve the diagnotic ability to CHD, though expanding the sample size were stilled needed.