Usefulness Of Three-dimensional Speckle Tracking Imaging Combined With SYNTAX Score In Evaluting Complex Coronary Artery Disease

Objective To discuss the value of the three-dimensional speckle tracking imaging(3D-STI)combined with the coronary artery SYNTAX score in evaluating the left ventricular function of patients with complex coronary artery disease and to explore the value of 3D-STI in the choice of revascularization in patients with complex coronary artery disease.Methods A total of 138 patients who were treated in the Affiliated Hospital of Qingdao University from March 2018 to June 2019,scheduled for coronary angiography(CAG),were enrolled in this study.Moreover,30 healthy volunteers were selected as the control group.The patients were divided into the complex lesion group(3-vessel stenosis>70% and/or LM stenosis rate>50%,n=103)and the non-complex lesion group(1/2-vessel stenosis>70%,n=35)according to the CAG.Then the complex lesion group was further divided into the low score subgroup(SYNTAX score<23,n=33),the medium score subgroup(23?SYNTAX score<33,n=34)and the high score subgroup(SYNTAX score?33,n=36)based on the SYNTAX score.All patients were examined by conventional ultrasound and 3D-STI before CAG.The left ventricular end-diastolic internal diameter(LVIDd),left ventricular end-systolic internal diameter(LVIDs),left ventricular end diastolic volume(LVEDV),left ventricular ejection fraction(LVEF)were obtained by the conventional ultrasound.The global longitudinal strain(GLS),global radial strain(GRS),global circumferential strain(GCS),global three-dimensional strain(G3DS)and 16 segment strain parameters were measured by 3D-STI.Then the mean longitudinal,radial,circumferential and three-dimensional strains of basal,middle and apical segments(LS-Bas,RS-Bas,CS-Bas,3DS-Bas,LS-Mid,RS-Mid,CS-Mid,3DS-Mid,LS-Ap,RS-Ap,CS-Ap,3DS-Ap)were calculated.The parameters among the groups were compared.The receiver operating characteristic(ROC)curves were drawn and the susceptibilities of the indexs to detect the degree of complex coronary artery stenosis were analyzed.The correlation between the global strain parameters and the SYNTAX score were analysed by the Pearson correlation analysis.And the interobserver and intraobserver consistency were showed by the Bland-Altman test.Results(1)The G3 DS,GLS,GRS,GCS,LS-Bas,3DS-Bas,LS-Mid,RS-Mid,CS-Mid,3DS-Mid,RS-Ap,LS-Ap,CS-Ap in the non-complex lesion group and the all the 3D-STI parameters of the complex lesion group were lower than those in the control group.The G3 DS,GLS,GRS,GCS and LS-Bas,CS-Bas,3DS-Bas,LS-Mid,RS-Mid,3DS-Mid,LS-Ap,3DS-Ap in the complex lesion group were lower than those in the non-complex coronary heart disease group(all P< 0.05).(2)The GLS,GCS,G3 DS,3DS-Bas,LS-Bas,CS-Ap,RS-Ap,3DS-Ap of the medium score subgroup and the G3 DS,GLS,GRS,GCS,LS-Bas,3DS-Bas,CS-Bas,LS-Mid,RS-Mid,CS-Mid,3DS-Mid,LS-Ap,RS-Ap,CS-Ap,3DS-Ap of the high score subgroup were lower than those in the the low score subgroup.The GLS,G3 DS,LS-Bas,RS-Mid,3DS-Mid,LS-Ap of the high score subgroup were lower than those in the the medium score subgroup(all P< 0.05).(5)ROC curve showed that the GLS,GRS,GCS,G3 DS had a certain value in detecting degrees of complex coronary artery disease.The area under the curve(AUC)of GLS,GRS,GCS and G3 DS in patients with low score complex lesions was 0.790,0.732,0.713 and 0.801 respectively;the AUC of GLS,GRS,GCS and G3 DS in patients with middle score complex lesions was 0.810,0.751,0.769 and 0.818 respectively;the AUC of GLS,GRS,GCS and G3 DS in patients with high score complex lesions was 0.814,0.737,0.766 and 0.805.(4)Pearson correlation analysis showed that GLS,GCS,GRS,G3 DS were negatively correlated with the coronary SYNTAX score in the complex lesions group(r =-0.616,-0.413,-0.523,-0.576,all P< 0.05).(5)The repeatability test showed that 3D-STI had good interobserver and intraobserver consistency.Conclusions(1)3D-STI combined with the coronary artery SYNTAX score can be used to evaluate left ventricular function in patients with complex coronary artery disease to a certain extent.(2)The GLS,GRS,GCS,G3 DS of 3D-STI can be used to evaluate had a certain value in detecting degrees of complex coronary artery disease,and the GLS and G3 DS have the larger area under the curve,which means 3D-STI can help patients with complex coronary artery disease to select the treatment method.