Clinical Study Of Three-dimensional Speckle Tracking Echocardiography In Evaluating Myocardial Changes Before And After PCI In Patients With NSTE-ACS

Objective: To identify ischemic myocardium in patients with non-ST segment elevation coronary syndrome(NSTE-ACS)by non-invasively using 3D-speckle tracking technique(3D-STI)The location and corresponding coronary lesions were analyzed.The enhancement of ischemic myocardial movement after percutaneous coronary intervention(PCI)was analyzed,and the effect of PCI was evaluated.Method:1.Totals of 130 patients with NSTE-ACS were selected.Two-dimensional speckle tracking technique(2D-STI)and 3D-STI were performed after admission.Echo Pac and 4D-AUTO-LVQ workstation were used.The workstation conveied the longitudinal strain,the circumferential strain,and the radial strain-time curve of the whole left ventricle and each 16 segments.Coronary angiography(CAG)was performed to confirm that the main coronary artery≥1 branch of the proximal and/or middle stenosis was greater than 70%,and PCI was performed.2.In the same period,50 patients with CAG showed no abnormality in coronary artery,2D-STI and 3D-STI examination were employed to get left ventricular global longitudinal strain and left ventricular global circumferential strain,left ventricular global radial strain,the receiver operating characteristic curve was used to evaluate 2D-STI and 3D-STI versus Diagnostic efficacy of NSTE-ACS.3.According to the location and degree of coronary stenosis indicated by CAG,the corresponding myocardial segments were divided into ischemic segment group and non-ischemic segment group.Two groups of LS,CS and RS were compared by independent sample T test.The difference in strain parameters was used to evaluate the diagnostic performance of LS,CS and RS in each segment using ROC curve.4.Patients who were enrolled in NSTE-ACS were followed up for 6 months after PCI,and 3D-STI examinations were performed again.The ischemic segment group and the non-ischemic segment group were preoperatively and 6 months after surgery.LS,CS,and RS were paired with sample T test.The independent sample T test was employed on LS,CS,and RS in the ischemic segment group 6 months after PCI and non-ischemic segment group to quantitatively evaluate the ischemic segment group via PCI.Improvement in myocardial motion after 6 months of treatment.Result:1.ROC curve analysis shows that the AUC of LVGLS,LVGCS and LVGRS of 2D-STI is 0.711,0.640,0.533,the sensitivity is 0.72,0.66,0.74,at the same time,the specificity is 0.78,0.60,0.30,The AUC of LVGLS,LVGCS,LVGRS of 3D-STI is 0.769,0.754,0.571,the sensitivity is 0.85,0.68,0.73,the specificity is 0.64,0.76,0.42.The area under the curve in 2D-STI and 3D-STI is LVGLS>LVGCS>LVGRS,suggesting LVGLS and LVGCS It has higher diagnostic efficiency,and the sensitivity and specificity of 3D-STI for diagnosing NSTE-ACS are better than 2D-STI.2.The LS in the ischemic segment group was decreased in the left ventricle segment than non-ischemic segment group(P<0.01),The CS in the ischemic segment group was also decreased in the left ventricle segment than non-ischemic segment group(P<0.05),the remaining 14 segments were significantly reduced(P<0.01),while RS was significantly reduced in the basal segment of the anterior wall and the basal segment of the lateral wall(P<0.01),the basal segment of the posterior wall,the middle segment of the anterior wall,The middle segment of the posterior wall and the middle segment of the inferior wall were reduced(P<0.05),and the remaining segments had a decreasing trend,but it was not statistically significant.3.ROC curve analysis showed that the area under the curve of the left ventricle was LS >CS>RS.According to the 95% confidence interval and P value,LS and CS can be used to identify the ischemic myocardium of the left ventricle,the diagnostic efficiency of RS in each segment was no statistical significance(P >0.05).The basal LS of the ischemic segment was improved after 6 months after PCI(P < 0.05),and the remaining segments were significantly improved(P<0.01).The CS was in the middle of the sidewall and the apex of the lateral wall.There was no statistical difference between the segments and the preoperative changes(P>0.05).The RS was in the anterior wall basal segment,the middle segment of the anterior wall,the middle segment of the anterior wall,and the basal segment of the lateral wall.The middle segment of the side wall,the base segment of the posterior wall,the middle segment of the posterior wall,the middle segment of the inferior wall,and the middle segment of the posterior septum(9/16)were higher than those before surgery(P<0.05).There was no statistical difference in the remaining segments.5.Compared with the non-ischemic segment group,the LS of each segment of the ischemic segment was lower than that of the non-ischemic segment at 6 months after PCI(P<0.05).CS was in the basal segment and anterior wall of the anterior wall.Base section,side wall base section,rear wall base section,lower wall base section,front wall middle section,front partition middle section,side wall middle section,lower wall middle section,rear wall middle section,rear interval middle section,front wall The apical segment,the anterior wall apex segment,the lateral apex segment,and the inferior apical segment(15/16)were still lower than the non-ischemic segment(P<0.05).RS had statistical data in the anterior basal segment compared with the non-ischemic segment.The learning was reduced(P<0.05),and the remaining segments were not statistically changed compared with the non-ischemic segments(P>0.05).Conclusion:1.Segmental ventricular motility abnormalities occur after coronary stenosis.The sensitivity and specificity of 3D-STI are better than 2D-STI.It can be used for qualitative,quantitative and non-invasive evaluation of left ventricular regional myocardial contractile function.Ischemic myocardium was identified,and LS and CS were used as sensitive indicators for non-invasive recognition of left ventricular ischemic myocardium.The myocardial deformation ability and systolic function were evaluated.It can be used to guide the revascularization strategy and has high clinical value.2.NSTE-ACS showed significant improvement in LS at 6 months after PCI.Most of the segments had improved CS,while RS improved in the basal and middle segments of the myocardium before surgery,suggesting that LS after blood supply recovery.It is more sensitive than CS and RS.The coronary blood supply is better in the near segment.The 3D-STI can be used to quantitatively evaluate the postoperative outcome of PCI,evaluate the prognosis of patients,and reflect the improvement of cardiac systolic function.NSTE-ACS patients postoperatively.The 6-month myocardial systolic function was still significantly different from that of the non-ischemic segment.Follow-up and assessment of cardiac function should be continued to develop a personalized treatment plan.