| Objective: Discussing the correlation between the Regional Wall Motion Abnormalities (RWMA) and the stenosis site, and the degree of coronary artery by the Myocardial Contrast Echocardiography (MCE), which is one of left heart contrasts.Analyzing the advantages of left heart contrast echocardiography in diagnosis of coronary heart disease complications by comparing with UCG, and left heart contrast echocardiography also plays an important role in evaluating of myocardial perfusion and the left ventricular systolic function,then we can see the important value of Left heart contrast echocardiography in the diagnosis, treatment and prognosis of CHD.The main objective of this project is trying to find a facility and reliable way of the diagnosis, treatment, long-term follow-up and the judgment of prognosis of CHD patients.Methods: Choosing 90 patients who were suspected that be suffered CHD during 2016.7.1-2017.1.1 in our hospital, then through Ultrasonic Cardiogram (UCG), Left heart contrast echocardiography (MCE and LVO) and the coronary arteriography(CAG). During UCG and MCE, we saw the motion of cardiac ventricular, according to the 16 segmentation method, the positive(+) representative the RWMA and the feminine (-) represent NO-RWMA of course, after that we can calculate respectively the total number of positive patients and segments and feminine patients and segments.Then, according to the result of CAG, we divided 90 patients into 5 groups, group one who has no lesion, group two with the lesion in the Left anterior descending (LAD),group three represents the lesion in the left circumflex coronary artery (LCX), group four is the patients whose lesion in the Right coronary artery (RCA),and the last one'is including the person whose lesion in more than two main arteries. We divided into four levels according to the coronary artery stenosis with degree of narrowing of the lumen area: Grade I lesions: Lumen area shrink about 0% - 25%; Grade II lesions:Lumen area shrink about 26% - 50%; Grade?lesions: Lumen area shrink about 51%-75%; Grade IVlesions: Lumen area shrink about >75%. Labeling Grade ? -?lesions .as feminine result(-)and Grade ?-? .lesions as positive result (?). Calculating the statistics index such as sensitivity, specificity, false positive rate, false feminine rate, right index and positive self-agreement and so on between the RWMA through the UCG and MCE and the CAG shows the stenosis motions in the coronary artery.Then we. also can diagnose the complication of CAD such as Thrombosis, ventricular aneurysm formation, the room wall perforation caused by acute myocardial infarction(AMI), papillary muscle rupture, etc., then we can get the advantage by comparing with UCG. The result showed the clinical value of Left heart contrast echocardiography (MCE and LVO) in diagnosis of CHD. We also discussed the relationship between the myocardial perfusion(the normal myocardial contrast agent perfusion, the myocardial contrast agent perfusion reduction and the myocardial contrast agent perfusion defects) and the coronay microcirculation dysfunction result from the coronary artery's stenosis, and got the LVEF% come from UCG and LVO,doing paired-samples t-test between them ,and maybe we can see the significance of Left heart contrast echocardiography (MCE and LVO) in evaluating the left ventricular systolic function accurately. And by this, we tried to find the function of MCE in judging the prognosis of CHD. For all the jobs, we can probe the clinical application of Left heart contrast echocardiography (MCE and LVO) in diagnosis and treatment of CHD,Results: 1 .There are 21 feminine patients and 69 positive patients in selected 90 patients according to the results from the golden standard-CAG.And the 69 feminine patients are made up of 13 patients whose lesions in LAD, 10 patients' lesions in LCX,8 patients' lesions in RCA and 38 patients whose lesions in the more than two main coronary arteries.2. There are 336 segments in total of 21 feminine patients that are defined by the CAG,the results come from UCG and MCE respectively are: UCG: there are 3 positive patients and 18 feminine patients, in another way, are 8 positive segments and 328 feminine segments. MCE: there are 3 positive patients and 18 feminine patients, in another way, are 8 positive segments and 328 feminine segments. And the 69 positive patients have 1104 segments, doing UCG and MCE also: UCG: there are 49 positive patients and 20 feminine patients, in another way, are 323 positive segments and 781 feminine segments. MCE: there are 53 positive patients and 16 feminine patients, in.another way, are 334 positive segments and 770 feminine segments.3.There are 1440 segments in. 90 patients in total, MCE showing 1146 segments'myocardial contrast agent perfusion are normal(3), 127 segments' myocardial contrast agent perfusion are reducing(2) and 167 segments' myocardial contrast agent perfusion are defecting(1). Comparing with CAG, there are evidences 'to show the good correlation between MCE and the coronary microcirculation dysfunction result from the coronary artery's stenosis. And there are 59 patients with PCI, there are 338 positive .segments,and the positive segments are made up by 57 segments with normal myocardial contrast agent perfusion(3),98 segments who's myocardial contrast agent perfusion are reducing and 165 segments is defecting of myocardial contrast agent perfusion. And a month later, these patients are through MCE again, there are 126 segments better. than before, and among these segments, 41 belong to normal segments (3), 82 segments' myocardial contrast agent perfusion are reducing (2), 3 segments' myocardial contrast agent perfusion are defecting (1).This strongly shows that MCE plays an important role in judging the location and degree of myocardium by evaluating the myocardial contrast agent perfusion.4.We get the LVEF% of 90 patients from UCG and MCE, then doing paired-samples t-test between them, the result shows that statistical significance existed, and we can't deny the most important role of MCE in evaluating the left ventricular systolic function accurately.5.In 69 positive patients diagnosed by the CAG, UCG shows 6 patients diagnosed with apex mural thrombus formation, 3 cases of apex thrombosis is not certainly ;4 cases of ventricular aneurysm formation; Ventricular free wall perforation in 2 cases.Left heart contrast echocardiography (MCE and LVO) in the diagnosis of 8 cases of apex of thrombosis, which confirmed the UCG doubt apex in 3 cases of suspected blood clots, ruled out the apex of 1 case of UCG diagnosis of thrombosis; 5 cases of ventricular aneurysm formation, ventricular free wall perforation in 2 cases. By this,we can prove the advantage of MCE in the diagnosis of coronary heart disease complications, especially the apex of thrombus, room wall has a clear advantage.Conclusion: There are evidences to display the RWMA of Left heart contrast echocardiography (MCE and LVO) and the stenosis of coronary artery have a good correlation, In the diagnosis of coronary heart disease complications, especially the apex of thrombosis, aneurysm formation, and ventricular free wall perforation has obvious advantages in the UCG And the myocardial perfusion(the normal myocardial contrast agent perfusion, the myocardial contrast agent perfusion reduction and the myocardial contrast agent perfusion defects) not only about the Grade?-? lesions of coronary artery, but also have a good correlation to the coronary microcirculation dysfunction result from the coronary artery's stenosis and the coronary myocardial bridge, it's a good reminder for clinician to take intervention timely and effectively.What's more, Left heart contrast echocardiography (MCE and LVO) can provide a good index of he left ventricular systolic function accurately, it's so important for clinician to evaluate the cardiac function and the treatment of CHD. |
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