| Background:Coronary atherosclerosis heart disease (CAD) is one of the common heart disease serious harm to people’s health, caused by coronary atherosclerotic vascular lumen stenosis or occlusion led to a lack of oxygen to myocardial ischemia or necrosis. In recent years, the incidence of the disease is obviously rising trend in our country.[1] Accurate quantitative assessment of left ventricular myocardial systolic function has important clinical significance for diagnosis and treatment and curative effect observation in patients with CAD. Echocardiography is now of the most common imaging methods used to assess left ventricular myocardial function, however, the traditional echocardiographic measurement is subjective, semiquantitative, and detect the subtle changes of myocardial systolic function relatively insensitive. With the development of digital technology, the diagnosis of CAD tends to be found earlier lesions and can make the diagnosis objective and quantitative. In recent years, the ultrasonic cardiogram of myocardial strain imaging technology has developed rapidly: Tissue Doppler imaging (TDI) as a noninvasive cardiac detection technology, has been widely used in detection and diagnosis of CAD; In previous years the development of two-dimensional speckle tracking (2DT) technology overcomes the angle dependence of TDI and provides a number of new insights for myocardial mechanics and deformation process. But it has two aspects of limitation:firstly, due to the limit of two-dimensional plane, it can’t track the myocardial spots movement to the out-of-plane; secondly, the imaging cannot be obtained in the same cardiac cycle, so the myocardial movement and deformation information is not accurate. Ultrasound system developed in recently has the ability to access real-time left ventricular total volume of data, which makes it possible to perform speckle tracking in three dimensional space, so as to track real movement of myocardial. The purpose of this study is to explore the feasibility of3DT technical for evaluating end-systolic three-dimensional longitudinal strain (3DLSe) of left ventricular myocardium in patients with left anterior descending coronary artery (LAD) lesions.Objective:To explore the value of3DT technical for evaluating3DLSe of left ventricular myocardium in patients with LAD lesions.Methods:1.40patients with pure LAD lesions proved by coronary artery angiography (CAG)(LAD stenosis rate of50%or higher, LM, LCX and RCA not seen significant stenosis), were divided into two groups:ischemia group (acute anterior wall myocardial infarction non-occurred)20patients, infarction group (acute anterior wall myocardial infarction occurred) also20patients;43cases for control group, such as age, gender, blood pressure match with the patient group, the CAG showed each coronary artery saw no significant stenosis.2. Three-dimensional full volume dynamic image was collected in apical four-chamber view, and then3DLSe parameters of17segments of left ventricular wall and end-systolic three-dimensional global longitudinal strain (3DGLSe) were analyzed with4D Auto LVQ software. Value of mean3DLSe for LAD blood-supplied region (MO), adjacent region (M1) and remote region (M3) were calculated separately. All of the above parameters were compared between groups.3. Draw ROC curve, and then calculate the optimal cut-off value, sensitivity, specificity, and area under the ROC curve (AUC) of MO to predict LAD lesions.4. Merge the three groups of data, analysis the relationship between3DGLSe and Left ventricular ejection fraction(LVEF).5.30cases of the research object were drawed randomly and measured by the same observer and another experienced observer again after one month, respectively, comparing the difference between the interobserver and the intraobserver.Results:1. General information, such as:age, gender, height, body weight, body surface area, heart rate, systolic blood pressure, diastolic blood pressure, etc all had no statistically significant difference observed in the three groups (P>0.05); LVEDV, LVESV and LVEF had no statistically significant difference between ischemic group and control group (P>0.05); compared with the control group and the ischemia group, LVEDV, LVESV and LVEF were significantly reduced in the infarction group (P<0.01).2.3DLSe comparison in the three groups: Compared with control group, in ischemic group,3DLSe of all seven segments within LAD blood supply region were reduced, but there were no statistically significant difference within basal anterior and basal anterior septal segments (P>0.05), the rest of the five segments and MO were lower (P<0.05), each segment within adjacent region and M1, within remote region and M2all had no statistical significance (P>0.05),3DGLSe was reduced (P<0.01); in infarction group,3DLSe of all seven segments within LAD blood supply region and MO were significant reduced(P<0.01), all six segments within adjacent region were reduced, but there was no statistically significant difference within basal inferior septal segment (P>0.05), the rest of the five segments and M1were lower (P<0.05), within remote region and M2had no statistical significance (P>0.05),3DGLSe was reduced(P<0.01). Compared with ischemic group, in infarction group,3DLSe of all seven segments within LAD blood supply region and MO were significant reduced (P<0.01), all six segments within adjacent region were reduced, but there were no statistically significant difference within basal inferior septal and basal lateral segments (P>0.05), the rest of the four segments and M1were lower (P<0.05), within remote region and M2had no statistical significance (P>0.05),3DGLSe was reduced (P<0.01).3. Optimal cut-off value of MO to predict LAD lesions was-16.00%(sensitivity75.00%, specificity95.30%and AUC0.911).4. Good correlation were noted between3DGLSe and LVEF (r=-0.802,P<0.01).5. The mean difference of3DLSe within all seventeen segments of left ventricular segmental wall between the interobserver and the intraobserver were in the range of-1.0%～1.0%, the95%confidence interval (CI) of the mean difference were in the range of-10.0%～10.0%; the mean difference of M0, Ml, M2and3DGLSe between the interobserver and the intraobserver were in the range of-0.5%～0.5%, the95%CI of the mean difference were in the range of-5.0%～5.0%. Therefore have good consistency.Conclusions:This study using3DT technology for evaluating3DLSe of left ventricular myocardium in patients with LAD lesions, the conclusion is as follows:1.3DLSe of left ventricular myocardium Can found myocardial ischemia more early than LVEF.2. Compared with control group, in ischemic group,3DLSe of all seven segments within LAD blood supply region were reduced, but there were no statistically significant difference within basal anterior and basal anterior septal segments (P>0.05), the rest of the five segments and M0were lower (P<0.05), each segment within adjacent region and M1, within remote region and M2all had no statistical significance (P>0.05),3DGLSe was reduced (P<0.01). 3. Compared with control group, in infarction group,3DLSe of all seven segments within LAD blood supply region and MO were significant reduced (P<0.01), all six segments within adjacent region were reduced, but there was no statistically ignificant difference within basal inferior septal segment (P>0.05), the rest of the five segments and Ml were lower (P<0.01),within remote region and M2had no statistical significance (P>0.05),3DGLSe was reduced (P<0.01).4. Compared with ischemic group, in infarction group,3DLSe of all seven segments within LAD blood supply region and MO were significant reduced (P<0.01), all six segments within adjacent region were reduced, but there were no statistically significant difference within basal inferior septal and basal lateral segments (P>0.05), the rest of the four segments and Ml were lower (P<0.01), within remote region and M2had no statistical significance (P>0.05),3DGLSe was reduced (P<0.01).5. Optimal cut-off value of MO for LAD lesions was-16.00%(sensitivity75.00%, specificity95.30%and AUC0.911)6. Good correlation were noted between3DGLSe and LVEF (r=-0.802, P<0.01).7. There have good consistency in relevant measurements:The mean difference of3DLSe within all seventeen segments of left ventricular segmental wall between the interobserver and the intraobserver were in the range of-1.0%～1.0%, the95%confidence interval (CI) of the mean difference were in the range of-10.0%～10.0%; the mean difference of M0, M1, M2and3DGLSe between the interobserver, and the intraobserver were in the range of-0.5%～0.5%, the95%CI of the mean difference were in the range of-5.0%～5.0%.8. The operation of this technology is convenient,and the image is intuitive, so it will have broad clinical application prospect in detection and diagnosis of CAD. |
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