| Coronary artery heart disease (coronary artery heart disease, CHD), is caused by coronary artery stenosis and insufficiency blood supply, which then resulted myocardial dysfunction and (or) organic diseases, so it is also called ischemic cardiomyopathy (IHD). CHD is the outcome of a variety of coronary artery disease, while coronary atherosclerosis coronary heart disease accounts for the vast majority of95%-99%. The occurrence of CHD closely relate with the degree and number of coronary atherosclerotic stenosis, while suffering from hypertension, diabetes, obesity, smoking, excessive drinking and other bad habits are the main factors which can induce CHD. CHD is one of the disease with the highest mortality in the world. In China the death toll has listed second in the world, according to the WHO2011report.Percutaneous coronary intervention (PCI) is a minimally invasive operation, which is more safety than coronary artery bypass (CABG) operation. PCI can reduce the fatality of thoracic operation in perioperative period greatly, and its therapeutic effect is perfect which drug treatment can not be compared. PCI has become one of the major treatment method of CHD. PCI can improve the cardiac function in patients with CHD effectively, relieve clinical symptoms, and plays an important role in the prevention of sudden death and improvement of the quality of life. PCI contains percutaneous translumin coronaryangioplasty (PTCA) and coronary stent implantation. It is very important for assessing the treatment to evaluate the movement of the myocardial tissue after successful PCI. At present, the methods for evaluation of myocardial perfusion include magneticresonance imaging (MRI), radionuclide myocardial perfusion imaging, electrocardiogram(UCG), echocardiography (ECG), etc. Echocardiography is widely used in clinical practice,as it is simple, noninvasive, repeatable and inexpensive.There are many echocardiography methods which can be used for the evaluation ofmyocardial movement currently, such as stress echocardiography (STE), myocardialcontrast echocardiography(MCE), tissue Doppler (TDI) and two-dimensional speckletracking technology (2D-STI).2D-STI is a new technology developed in recent years. The ultrasound image containsmany acoustic speckles which evenly distirbuted in the myocardial tissue. These acousticspeckles have the same synchronous movement as myocardial tissue, whose wavelength isless than that of the ultrasound. The displacement of these acoustic speckles represent themovement of the myocardium. By mapping the trajectory of the myocardium of the samelocation, myocardial tissue deformation could be measured. There is no relationshipbetween2D-STI and Tissue Doppler frequency shitf, so it was is not influenced by theangle between the direction of ultrasound beam and wall motion.2D-STI can be used todetecte the movement of global and regional myocardial function in the long axis and shortaxis, and provide a new quantitative method ofr the assessment of mechanics of themyocardial global and regional motion.Tissue motion tracking of mitral annular displacement (TMAD) is a new technologywhich is based on two-dimensional speckle tracking imaging. TMAD technology is asimple tool, which uses semi-automatic method to track the movement of the valve irngrelative to the letf ventricular apical, and it is independent of angle. It has been shown thatTMAD can be used to evaluate the letf ventricular systolic function, particularlylongitudinal systolic function.This study included three parts as follow: Part1Preliminary clinical study of left ventricular global systolic function in patients with coronary artery heart disease by automated motion tracking of mitral annular displacementObjective To assess the left ventricular global systolic function in patients with coronary artery heart disease by automated motion tracking of mitral annular displacement (TMAD).Methods55patients with coronary artery heart disease (more than one coronary artery stenosis≥70%, which were confirmed by coronary angiography) and35age-matched normal controls were enrolled in this study. The patients were divided into two subgroups according to LVEF:Group A (LVEF≥50%) and Group B (LVEF<50%). After routine echocardiography by Philips IE33with S5-1probe (the frequency is1.7～3.4MHz, frame rate>60frame/sec), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF) were measured by biplane Simpson’s method. Apical four-chamber, three-chamber and two-chamber two-dimensional dynamic images were stored, which lasted three to five consecutive cardiac cycles. The parameters were obtained using Qlab7.0software offline:maximal systolic displacement (Ds) of every annulus, systolic displacement of the middle point (D-mid), long-axis fractional shortening (FSL), then the mean of Ds, D-mid and FSL were calculated respectively. The correlation between mitral annular motion parameters and LVEF were analyzed.Results①The mean of Ds, D-mid and FSL were significantly decreased in group A and group B, compared with normal controls (P<0.05for all). Compared with group A, the mean of Ds, D-mid and FSL were significantly decreased in group B (P<0.05)②TMAD was less time-consuming than biplane Simpson’s method(P<0.001), and the time for each method were(174.70±29.98)s and (235.15±38.35)s, respectively.③There was correlation between the mean of Ds, the mean of D-mid, the mean of FSL and LVEF (r=0.769,0.748,0.784, P<0.001) in normal group, and there was also correlation between the mean of Ds, the mean of D-mid, the mean of FSL and LVEF in CHD group (r=0.780,0.796,0.782, P<0.001).④Intraobserver and interobserver reliability for the mean of Ds, D-mid, and FSL were acceptable. Intraobserver ICC values of the mean of Ds, D-mid, and FSL were0.87,0.85,0.93, and interobserver ICC values were0.84,0.84,0.88, respectively.Conclusions TMAD technology was a simple, accurate, and objective method, which can be used to evaluate the left ventricular global systolic function in patients with coronary artery heart disease. Objective To assess the left ventricular global systolic function in patients with coronary artery heart disease before and after PCI operation by tissue automated motion tracking of mitral annular displacement (TMAD).Methods20patients with coronary artery heart disease who were successfully undergone PCI, and successfully tracked for6months (coronary artery stenosis≥70%, which were confirmed by coronary angiography),14males and6females, aged from39to67years old with an average of (52.75±5.86) years old were enrolled in this study. And31age-matched normal controls were enrolled in this study,21males and10females, aged from33to59years old with an average of (52±9.6) years old. After routine echocardiography by Philips IE33with S5-1probe (the frequency is1.7～3.4MHz, frame rate>60frame/sec),left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF) were measured by biplane Simpson’s method. Apical four-chamber, three-chamber and two-chamber two-dimensional dynamic images were stored, which lasted three to five consecutive cardiac cycles. The parameters were obtained using Qlab7.0software offline:maximal systolic displacement (Ds) of every annulus, systolic displacement of the middle point (D-mid), long-axis fractional shortening (FSL), then the mean of Ds, D-mid and FSL were calculated respectively.Results①Compared with normal controls, LA、LV、LVEDV、LVESV in patients with coronary artery heart disease were increased, while LVEF was decreased(P<0.05). The mean of Ds (10.95±1.70mm vs13.01±1.46mm), D-mid(11.41±1.74mm vs13.69±1.54mm) and FSL (13.74±2.17mm vs17.27±2.56mm) were signifycantly decreased in pre-operation group compared with normal controls (P<0.05for all).②The mean of Ds(13.63±1.20mm vs10.95±1.70mm),D-mid (14.18±1.20mm vs11.41±1.74mm) and FSL (17.26±1.86mm vs13.74±2.17mm) were signifycantly increased in post-operation group compared with pre-operation group (P<0.05for all).③There were no significant difference between the post-operation group and normal controls for the mean of Ds, the mean of D-mid, and the mean of FSL.④There was correlation between the mean of Ds, the mean of D-mid, the mean of FSL and LVEF (0.721、0.715,0.838, P<0.001) in post-operation group.Conclusions The left ventricular global systolic function was obviously improved in patients with coronary artery disease after PCI operation. TMAD technology could be used for assessment of left ventricular global systolic function in coronary heart disease patients after PCI operation as a good follow-up tool. Part3The evaluation of of left ventricular regional systolic function in patients with coronary artery heart disease before and after PCI operation by two-dimensional speckle tracking imagingObjective To assess the left ventricular regional systolic function in patients with coronary artery heart disease before and after PCI operation by two-dimensional speckle tracking imaging (2D-STI).Methods20patients with coronary artery heart disease who were successfully undergone PCI, and successfully tracked for6months (coronary artery stenosis≥70%, which were confirmed by coronary angiography),14males and6females, aged from39to67years old with an average of (52.75±5.86) years old were enrolled in this study. And31age-matched normal controls were enrolled in this study,21males and10females, aged from33to59years old with an average of (52±9.6) years old. After routine echocardiography by Philips IE33with S5-1probe (the frequency is1.7～3.4MHz, frame rate>60frame/sec),left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF) were measured by biplane Simpson’s method. Apical four-chamber, three-chamber and two-chamber two-dimensional dynamic images were stored, which lasted three to five consecutive cardiac cycles. The parameters were obtained using Qlab7.0software offline:longitudinal peak systolic strain and strain rate of the seven myocardial segments which was supplied by the left anterior descending artery.Results①Compared with normal controls, LA、LV、LVEDV、LVESV in patients with coronary artery heart disease were increased, while LVEF was decreased(P<0.05).②The longitudinal peak systolic strain and strain rate of ApA、MA、BA、ApS、MAS、BAS and Apex and Apex were signifycantly decreased in pre-operation group compared with normal controls (P<0.05for all).③The longitudinal peak systolic strain and strain rate of ApA、 MA、BA、ApS、MAS、BAS and Apex were signifycantly increased in post-operation group compared with pre-operation group (P<0.05for all).④There were no significant difference between the post-operation group and normal controls for the longitudinal peak systolic strain of MA、BA、MAS、BAS and Apex, and there were significant difference between the post-operation group and normal controls for the longitudinal peak systolic strain rate of ApA and Apex.Conclusions The left ventricular regional systolic function was obviously improved in patients with coronary artery disease after PCI operation.2D-STI could be used for assessment of left ventricular regional systolic function in coronary heart disease patients after PCI operation as a good follow-up tool. |
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