Viable Myocardium Evaluation Of Patients With Coronary Heart Disease Before CABG By 3D-STI And 2D-LS

BackgroundCoronary atherosclerotic heart disease,due to its increasing incidence year by year,poses a serious threat to the life and health of patients and reduces the quality of life of patients.Whether the cardiac function of patients with cardiac dysfunction caused by myocardial infarction can be restored after coronary artery bypass grafting and to what extent it can be improved remains a major problem for clinicians.Previous studies have shown that the improvement of cardiac function in patients undergoing coronary artery bypass grafting depends on the proportion of myocardial tissue surviving after myocardial infarction.In addition to cardiac magnetic resonance imaging(MRI)myocardial perfusion imaging,load cardiac MRI,SPECT myocardial imaging of SPECT myocardial perfusion imaging and SPECT myocardial metabolic imaging can realize effective evaluation of survival myocardium,due to the operation process is relatively complex,has certain risks and contraindications,by certain limits,in the clinical application of two-dimensional layered strain(2d-LS)technology and three dimensional ultrasound speckle tracking imaging(3d-STI)technology is developed in recent years to ultrasound technology,overcome the limitations of the existence of tissue doppler imaging,realizes the quantitative evaluation from the perspective of myocardial mechanics systolic function of left ventricular global and local.This study by two-dimensional ultrasound for each segmental left ventricular wall myocardial ventricular wall motion analysis,and then viewing room wall motion after bypass surgery,improve to assess myocardial viability,2dLS with 3d-STI survival myocardium in patients with coronary heart disease(CHD)to assess the accuracy of the help reduce perioperative mortality,help clinical doctors treatment selection and prognostic judgement.ObjectivesTo evaluate the clinical value of using 3D speckle tracking technique and 2D stratified strain technique to evaluate myocardial viability before coronary artery bypass transplantation.MethodsThrough the heart of two-dimensional ultrasound assessment of left ventricular systolic function in patients with coronary heart disease,selection of ejection fraction <50% of 20 patients with coronary heart disease(CHD)as the research object,in the CABG surgery through two-dimensional layered strain measurement each segment of the left ventricular chamber wall long axis layered peak strain values,which include lining endomyocardial longitudinal strain(Endo-LS),mid-myocardial longitudinal strain(Mid-LS)and the epicardial longitudinal strain(Epi-LS),And through the three-dimensional speckle tracking technology to strain peak value of the measured 3d ring is 3d-CPS,long axis strain is 3d-LPS,radial strain 3d-RPS,and area of strain that is 3d-APS,respectively in preoperative 1 week and 6 months after the conventional echocardiography,to observe left ventricular wall in every heart sarcomere in two-dimensional dynamic images,movement and rate,analysis and comparison before and after surgery the segmental ventricular wall motion and changes of the score,as a standard to the heart of the ventricular wall motion abnormalities present sarcomere section division,is divided into viable myocardium group and non-viable myocardium group.ResultsCABG surgery survival myocardium group 2 d and 3 d strain parameters of the absolute value is significantly higher than the survival myocardium group,the comparison between the two groups were statistically significant(P < 0.05),the participants work curve analysis shows that,in the film,the outer membrane lining the myocardial LS and the three dimensional strain parameters to predict survival myocardium has a certain value(AUC > 0.50,P < 0.05),including preoperative in 3d-AS-9.5 or less for the cut-off value evaluation value of survival myocardium was obviously higher than that of other parameters,its diagnosis survival myocardium AUC is 0.92,the sensitivity is 0.86,the specificity is 0.83,the Kappa value is 0.642.ConclusionTwo dimensional stratified strain and three dimensional speckle-tracking techniques can be used to evaluate the viable myocardium before CABG,and the truncation value of three dimensional strain parameter 3D-AS ≤-9.5 is the highest value to judge the viable myocardium.