Study On Evaluation Of The Wall Motion In Patients With Suspect Coronary Heart Disease By Real-time Three-Dimensional Echocardiography And Two-Dimensional Speckle Tracking Imaging

Objective:To evaluate the left ventricular wall motion function in the patients suspected coronary heart disease (CHD) by the real-time three dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STI).Methods:One hundred and forty-three hospitaized patients with suspected CHD were enrolled in the research, They had a normal or only T wave change in rest electro-cardiogram (ECG) and had a normal left ventrical wall motion in echocardiography. They were to undergo coronary angiography and left main artery and/or anterior descending and or Left circumflex branch were narrow. According to their coronary arteries narrow extent, the patients were divided into stenosis≥575%group (ischemic group, group A) including seventy-three cases, and stenosis<75%group (normal control group, group B) including seventy cases. Excluding organic cardiopathy such as congenital heart disease, valvular disease, myocardial infarction, heart failure, cardiomyopathy etal; excluding the disease that affect cardiac structure and function such as hepatic and renal insufficiency, immunological diseases, tumor, pulmonary heart disease, et al; excluding the patients who receive cardiac surgery such as permanent pacemaker implantation or cardiac resynchronization therapy (CRT) et al. The patients who had a poor quality of ultrasonic images wew excluded. Recording the patient’s general conditions including height, weight, heart rate, history of hypertension and diabetes, smoking, drinking et al.Echocardiography examination was performed using an Philips iE33echocardio-garphic system with X5-1transducer (1.0-5.0MHz). All patients were examined by regularly ultrasonic cardiography to measure left ventricular ejection fraction (LVEF); The images of apical four-chamber, apical three-chamber and apical two-chamber section were acquisited. Activatig Full Volume imaging in apical four-chamber, four consecutive cardiac cycle full-volume date was collected. All of date were stored.17segmental volume-time curves (VTCs) and bull’s-eye maps were measured by QLab3DQ Advanced software. Recording left ventrical end diastolic volume (EDV), end systolic volume (ESV), LVEF, segmental end diastolic and systolic volume (sEDV, sESV), the time to minimum systolic volume of16-segmental standard deviation (Tmsv-16-SD) and maximal difference (Tmsv16-Dif), the time to minimum systolic volume of16-segmental standard deviation and maximal difference as a ratio of R-R interval (Tmsvl6-SD%),(Tmsvl6-Dif%). Calculating standard deviation and maxi-mal difference in the time to minimal systolic volume in each level segment (Tmsv-SD) and Tmsv-SD as a ratio of R-R interval of the three regions, which were ETmsv-SD, ETmsv-Dif, ETmsv-SD%, MTmsv-SD, MTmsv-Dif, MTmsv-SD%, ATmsv-SD, ATmsv-Dif, ATmsv-SD%, calculating the left ventrical segmental, average segmental and regional ejection fraction (sEF, sEF’and REF). The peak systolic longitudinal strain (SL) of all patients were measured using Q-Lab CMQ software. All clincal datas were statistically analyzed and processed.Results:1. No significant statistic significant in clinical data and cardiac structure index tested by conventional echocardiography in the two group (p>0.05).2. The LVEF measured by RT-3DE was significantly lower than that measured by2-DE in the group A (p<0.05).3.17Segmental VTCs are "U-shaped" and uniform and the coordinates of curve peak and valley are nearby in the group B. In the group A, VTCs was irregular and clutter, normal segmental amplitude is larger, ischemic segments amplitude is small or even reverse movement.4.17segment bull’s-eye map of the patient was displaying all left ventricular segmental are green in the group B. In the group A, left ventricular segmental displaying are green, blue or red part of the section according to different wall motion.5. The sEF of every segment in the group B and the sEF of inferior, posterior in the group A were increased in a smooth progression from base to apex, there was significant statistical difference from base to middle (p<0.05), but there was no statistical differences between middle segments and apical segments (p>0.05); the sEF and REF of every segment dominated by narroed coronary lost the above regulation.6. The sEF in the basal, mid, apical segment of anterior, anteroseptal; mid inferosepta; mid, apical segment of anterolateral and REF of apex region were significantly reduced in group A (p<0.05). 7. The SL in the basal, mid, apical segment of anterior, anteroseptal; mid, apical segment of anterolateral were significantly reduced in the group A ((p<0.05).8. The sEF’were positively correlated with16segmental average SL; as sEF, SL of the segment dominated by narroed coronary as test variable, as the myocardial ischemia as state variables to make ROC curve analysis indicated that the under-curve areas of every segmental sEF were higher than SL.9. Compared with the group B, some systolic dyssynchrony indices (Tmsv-16-SD, Tmsv-16-Dif, Tmsv-16-SD%, Tmsv-16-Dif%, ETmsv-SD, ETmsv-SD%, MT-msv-SD, MTmsv-Dif, MTmsv-SD%, ATmsv-SD, ATmsv-SD%) were significantly higher in the group A (p<0.05).10. There were no significant correlations between global systolic synchrony parameters (Tmsv-16-SD, Tmsv-16-Dif, Tmsv-16-SD%, Tmsv-16-Dif%) and LVEF in the group A, but which were inversely correlated with sEF’(p<0.05), while the regonal systolic synchrony parameters also increased as corresponding REF decreased in the group A; the correlations between SDI, ATmsv-SDI and sEF’,REF were modest (r=-0.327, r=-0.518).Conclusion1. In the ischemic group, the irregular17segmenta VTCs illustrated and the colour nonuniform bull’s-eye maps illustrated suggested that the wall movemen abnormalities can be early tested using of RT-3DE images. The method is simply and directly.2. Compared with the normal group, sEF and SL of some segments dominated by narroed coronary were decreased, the regularity of segmental ventricular wall movement disappear in ischemic group, which suggested regional wall motion in stenosis of coronary artery (≥75%) without wall motion abnormality can be assessed rapidly, objectively and quantitatively by use of RT-3DE and2D-STI, which provide more clinical information for early diagnosis of myocardial ischemia.3. The sEF of RT-3DE and the SL of2D-STI were modest positively correlation, but for the diagnosis of myocardial ischemia in the stenosis of coronary artery (≥75%), compared with SL, sEF, especially the sEF of anteroseptal apex region has higher under-curve areas, so the clinical application value of RT-3DE is more hinger than2D-STI for such patients.4. Global and regional systolic dyssynchrony indices were increase and were inversely correlated with sEF and REF in ischemic group, which suggested LV synchronicity is significantly impaired after myocardial ischemia. The left ventricular dyssynchrony can be evaluated quantitatively, intuitively with RT-3DE for myocardial ischemia patients without wall motion abnormality. There is significance on early diagnosis, the judgmen of disease severityt and treatment and prognosis for such patients.5. The LVEF measured by RT-3DE was significantly lower than that measured by2-DE in the ischemic group, whether RT-3DE is better than2-DE in the measurement of left ventricular function, further research is needed to confirm.