| Objective:To investigate early stage changes of myocardial microcirculation and systolic function in patients with ischemia and nonobstructive coronary artery diseases(INOCA)by myocardial contrast echocardiography(MCE)and two-dimensi-onal speckle tracking echocardiography(2D-STE).Methods:According to the inclusion criteria and exclusion criteria,50 patients who were admitted to Cardiology Department from December 2018 to October 2019 and in conformity to INOCA diagnosis were selected to be case group,there were 22 males and 28 females,with an average age of 59.73±7.72 years.35 health examinees during the same period were chosen as control group,including 16 males and 19 females,with an average age of 59.94±7.25 years.All patients signed written consent for participation in the clinical study.All research objects received general clinical data collection,two-dimensional echocardiography,MCE and 2D-STE examination to obtain relevant parameters,including LVEDD,LVEDV,LVESV,LVEF,E,A,Em,Am,MCS and GLS.Using statistical software of SPSS 24.0(SPSS,Chicago,IL,USA)to analyze the data.Continuous variables were expressed as mean ± standard deviation,and the comparison between two groups was performed using independent sample t test.Nonparametric variables were expressed as rate(%),using3/test or Fisher exact probability method.The intraclass correlation coefficient(ICC)and Bland-Altman plot analysis were used to analyze the consistency of inter-observer and intra-observer measurement of left ventricular GLS.The weighted Kappa method was used to analyze the consistency of the evaluation of the degree of myocardial perfusion among observers.P value of less than 0.05 was considered to be statistically significant.Results:There age,gender,heart rate,body mass index(BMI)and blood pressure between the two groups were not significantly different.Compared with the normal control group,the E value and E/A value of the INOCA group were lower,and the differences were statistically significant.There were no statistically significant differences in LVEDD,LVEDV,LVESV,LVEF,A,Em,Am between the two groups The left ventricular GLS value of the INOCA group was(-14.82±2.58)%,which was lower than that of the control group(-20.31±1.08)%,and the difference was statistically significant.In the INOCA group,MCS scores of 0.5 and 1 were 39(78.0%)and 11(22.0%),respectively.The MCS of the control group was 1 point.The difference between the two groups was statistically significant.Bland-Altman drawing analysis method showed the mean inter-observer and intra-observer difference of GLS of left ventricular myocardium were-0.2%and-0.4%,the 95%confidence interval(CI)were in the range of(-3.6%?3.2%)and(-7.4%?6.7%),respectively.It was demonstrated that GLS of left ventricular myocardium had good inter-observer and intra-observer consistency.In the inter-observer and intra-observer,the ICC values of left ventricular GLS were 0.81 and 0.77,the 95%confidence interval(CI)were in the range of(0.702?0.894)and(0.603?0.867),respectively.It was demonstrated that GLS of left ventricular myocardium had good inter-observer and intra-observer reliability.The analysis results of the weighted Kappa coefficient showed that the assessment of myocardial perfusion in 44 patients was consistent in the inter-observer,and the assessment of 6 patients was inconsistent.The weighted Kappa value is 0,735,and the 95%confidence interval(CI)is in the range of(0.539?0.930),indicating strong consistency.Conclusion:MCE and 2D-STE are two new ultrasound technologies.The combination of the two could be used to evaluate the changes of abnormal myocardial microcirculation and systolic functions in patients with INOCA earlier and sufficient.It provides a reference for intervention and assessment of prognosis. |
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