Three-Dimensional Speckle Tracking Imaging Assessment Of Coronary Chronic Total Occlusion Of Early After Percutaneous Coronary Intervention On Left Ventricular Systolic Function

Objective:To investigate the changes of left ventricular systolic function in early postoperative patients with coronary chronic total occlusions?CTO?treated with percutaneous coronary intervention?PCI?by three-dimensional Speckle Tracking Imaging?3D-STI?.Methods:From December 2017 to October 2019,43 patients with CTO lesions were included,who were in liaoning provincial people's hospital.Inclusion criteria:total occlusion of the right coronary artery,the left anterior descending coronary artery and the circumrotatory coronary artery was confirmed by coronary angiography.According to clinical symptoms and objective evidence,the course of disease was at least 3 months.The results of coronary angiography were consistent with the number of enrolled 43 patients:4patients were excluded due to poor acoustic transmission of sonographic images and unclear display of the endocardial boundary of three-dimensional images.Finally,39patients,aged 57.87±10.46 years,33 males and 6 females,29 with a history of smoking,19with a history of drinking,12 with diabetes,11 with hyperlipidemia,26 with hypertension and 31 with obesity,single lesions right coronary artery blocked 20 cases,left cyclotron coronary vein blocking 5 cases,left anterior descending coronary artery blocking 10 cases,multiple lesions right coronary artery and left anterior descending coronary artery blocking2 cases,l left anterior descending coronary artery and circumrotatory coronary artery was blocking 2 cases,were meet a criterion in this study.All patients underwent two-dimensional echocardiography,3D-STI analysis and coronary angiography one day before PCI.and those patients confirmed by coronary angiography as CTO and who successfully opened the diseased vessels were re-examined by ultrasound and 3D-STI within 72 hours after the surgery.All parameters were collected using the same ultrasonic inspection instrument GEvivi E9,according to A 2018 ASE adults by routine thoracic echocardiography guidelines to keep figure and to measure ultrasound parameters:before and after the end of the left atrial contraction diameter?LA,unit:mm?,left ventricular end-diastolic diameter?LV,unit:mm?,left ventricular end-diastolic volume?EDV,unit:ml?,left ventricular volume?SV,unit:ml?,left ventricular ejection fraction?EF,unit:%?,ventricular wall motion score index?WMSI?,the bicuspid valve early diastolic peak flow velocity?peak E,unit:cm/s?,the bicuspid valve late diastolic peak flow velocity?peak A,unit:cm/s?,E/A,tissue Doppler measurement of left ventricular lateral wall early diastolic motion velocity(e'_Lateral,unit:cm/s),ventricular septum early diastolic motion velocity(e'_Septum,unit:cm/s),e'=(e'_Lateral+e'_Septum)/2,E/e';The collected full-volume data was stored,and all images were analyzed offline with echopac-110 software.The left ventricle strain parameters included:Global longitudinal strain?GLS?,global circumference strain?GCS?,global radial strain?GRS?,and global area strain?GAS?of the left ventricle were used to analyze the preoperative and postoperative parameters of the patients.Results:1.Compared with the results of two-dimensional ultrasound parameters and left ventricular strain parameters before and after PCI,there was no statistically significant difference in the changes of LA,LV,EDV,SV,EF,WMSI,E peak,A peak,E/A,e'and E/e'in the early after the surgery?p>0.05?.2.Changes of strain parameters before and after PCI:GAS?-10.77±3.79 vs-12.97±5.96,p<0.05?,GLS?-5.51±2.34vs-7.59±2.96,p<0.05?,GCS?-6.49±2.53vs-7.74±3.23,p<0.05?,GRS?12.49±4.82vs14.31±5.36,p<0.05?,GAS,GLS,GCS and GRS in the left ventricle were all increased compared with those before surgery,and the difference was statistically significant.The diagnostic value of GAS was the best?area under the ROC curve?GAS0.863,GLS 0.739,GCS 0.678,GRS 0.539??.Conclusion:3D-STI can evaluate the early left ventricular systolic function of CTO patients after PCI,and the left ventricular myocardial strain parameters GLS,GCS,GAS and GRS are improved compared with those before PCI.Among the above parameters,GAS has the best diagnostic value,so it is necessary to actively treat CTO patients.Compared with the traditional echocardiographic evaluation of left ventricular systolic function,3D-STI,as a new echocardiographic technique,can sensitively and quantitatively evaluate the changes in left ventricular systolic function at an early stage,so as to provide early efficacy evaluation for clinical patients.