| ObejctiveFamilial hypercholesterolemia (FH) has becoming a worldwide disease withcharacteristic of high risk of cardiovascular disorder and shortened lifespan in greatrequire of early diagnosis and treatment. Our study compare with gated99Tcm-methoxyisobutyl isonitrile (99Tcm-MIBI) myocardial perfusion imaging (MPI)with two-dimensional speckle tracking echocardiography (2D-STI), to discuss thereliability of2D-STI in detection of myocardial ischemia in Familialhypercholesterolemia (FH).MethodsA total of28patients with homozygote FH (HoFH) confirmed by clinical diagnosisdetected by rest/load99Tcm-MIBI MPI, TTDE and2D-STI. Compare the result ofmyocardial ischemia of HoFH patients seperatedly between TTDE,2D-STI and99Tcm-MIBI MPI. Correlation analysis of myocardial ischemia score and ejectionfraction (EF) was analysed between TTDE and MPI,2D-STI and MPI. According tothe result of MPI, separate the HoFH patients into myocardial ischemia team andnon-myocardial ischemia team, quantity analysis was carried through parameters ofgeneral conditions, TTDE and STI. In addition, compare between teams of segments strain of LAD, LCX, RCA according to the result of myocardial ischemia andnon-myocardial ischemia of MPI.Results(1)99Tcm-MIBI MPI showed13positive myocardial ischemia patients,15negativepatients. TTDE showed7positive motion abnormal patients,21negative patients.2D-STI showed15positive abnormal bull’s eye image patients,13negative patients.TTDE showed sensitivity is30.88%, specificity is98.77%, diagnose accordance rateis89.07%when compared with MPI on detect myocardial ischemia,2D-STI showedsensitivity is85.29%, specificity is95.34%, diagnose accordance rate is93.91%when compared with MPI on detect myocardial ischemia.(2) Spearmen correlation analysis showed correlation index of TTDE with99Tcm-MIB-I MPI is r=0.483(p<0.01), and correlation index of LAD, LCX, RCA is r=0.429,(p<0.01) r=0442(p<0.01) r=0.471(p<0.01) separately; correlation index of STI with99Tcm-MIBI MPI is r=0.786(p<0.01), and correlation index of LAD LCX RCA isr=0.843,(p<0.01) r=0.798(p<0.01) r=0.659(p<0.01) separately. The relativity of EFof TTDE with99Tcm-MIBI MPI is r=0.606(p=0.001), and the relativity of EF of STIwith99Tcm-MIBI MPI is r=0.919(p<0.001).(3) According to the MPI image, patients separate into myocardial ischemia and non-myocardial ischemia two grouops, there is no significance difference between generalconditions. TTDE showed significance difference of LVDd, LVDs, IVS, LVPW,AOVmax, PG, E/e’ and DT. STI showed less global strain, less global systolic andearly diastolic strain rate of myocardial ischemia patients versus non-myocardialischemia patients. ROC curve analysed parameters of STI showed high sensitivityand specificity with99Tcm-MIBI MPI.(4) According to the MPI image of myocardial ischemia of three main coronaryarteries separate into LAD, LCX, RCA three groups, statistical analysis showedsignificant defference of2D-STI segments strain is myocardium segments arranged by LAD.Conlusion(1) TTDE could be used primaritly to observe the ventricle motion of HoFH patients.(2) TTDE,2D-STI and99Tcm-MIBI-MPI all showed LAD is the counting most arteryof myocardial ischemia.(3)2D-STI is superior than TTDE in detect myocardial ischemia of HoFH patients.(4)2D-STI showed good relation with99Tcm-MIBI MPI,2D-STI is the excellent toolto evaluate the prognosis and curative effect of HoFH patients. ObejctiveA novel tool of Two-Dimensional speckle tracking imaging (2D-STI) allowsnoninvasive and angle independent measurement of global and regional myocardialabnormalities. The aim of this study was to assess whether STI can be useful to detectsubclinical cardiac involvement in FH patients.MethodsA total of47patients with FH confirmed by clinical diagnosis with normal ejectionfraction (EF) and37healthy matched controls underwent transthoracic Dopplerechocardiography (TTDE) and2D-STI examinations. Standard echocardiographicparameters were measured, LV end-diastolic dimension (LVIDd) and LVend-Systolic dimension (LVIDs), interventricular septum at end-diastole IVS andposterior wall at end-diastole LVPW maximum flow velocity of aorta (AOVmax)and pressure gradient of aorta (PG), left ventricle ejection fraction (LVEF),transmitral early diastolic velocity (E) and transmitral late diastolic velocity (A),transmitral early/late diastolic velocity ratio (E/A) and early diastolic decelerationtime (DT). Tissue Doppler Image measured early diastolic transmitral annularvelocity ratio (e’) and early transmitral/early diastolic mitral annular velocity ratio(E/e’). To observe motion conditions of left ventricle segments, cardiac structure, and function changed.2D-STI measured global longitudinal, circumferential and radialstrains (GLS, GCS, GRS), global systolic and early and late diastolic strain rates(GSRs, GSRe, GSRa), and regional strain and strain rate were detected respectively.Linear regression analysis was performed between LDL-C with variables (EF, GLS,GCS, GRS, GSRs, GSRe, GSRa).Results(1) FH showed larger left ventricular (LV) dimensions (LVIDd, LVIDs) and thickerLV walls (IVS, LVPW). Aorta’s pressure gradient (PG) and velocity (AOVmax)increased. Early diastolic deceleration time (DT), early transmitral/early diastolicmitral annular velocity ratio (E/e’) is higher than controls. EF, transmitral earlydiastolic velocity (E), transmitral late diastolic velocity (A) and transmitral early/latediastolic velocity ratio (E/A) were not statistically significant.(2) Longitudinal and circumferential strain significantly decreased whereas radial’sincreased. GSRs and GSRe significantly decreased in FH than controls (-1.18±0.29vs-1.42±0.24, p=0.01;1.68±0.50vs2.13±0.48, p<0.0001). LDL-c showedsignificant correlation with GLS, GCS and GRS.(3) The percentage of myocardium deformation of the coronary artery was80%in theleft anterior descending artery (LAD),66.7%in the left circumflex artery (LCX), and75%in the right coronary artery (RCA). Average strain values of LAD, LCX andRCA versus controls were-17.15(-38.12~72.14) vs-22.97(-40.35~69.12),-10.41(-29.41~75.9) vs-16.13(-31.44~81.12), and-17.39(-36.22~77.25) vs-20.91(-41.45~76.63) respectively. Conlusion(1)2D-STI could accurately evaluate LV systolic and diastolic function and makeearly diagnosis of FH.(2) Reductions in longitudinal and circumferential deformations are compensated forby increasing radial strain in FH having normal Left ventricle ejection fraction.(3) Myocardial abnormalities would occur earlier in early diastolic than late diastolicphase, SRe is a sensitive parameter to predict early diastolic function abnormality.(4) In this study, the main coronary artery with maximum myocardium deformation isLAD and the one with the worst lesion is LCX. Homozygous familial hypercholesterolemia (HoFH) is a rare hereditary disease inwhich severe cardiovascular atherosclerosis develops from birth due to geneticdefects in low-density lipoprotein-receptor (LDL-r) inherited from parents who areboth heterozygous-carriers of FH (HeFH). This report describes a case of a HoFHpatient underwent medical imageology examination for4years during the course oftreatment. Imaging techniques demonstrated development of ingravescentcardiovascular atherosclerosis. B-ultrasound showed carotid artery intima-mediathickness (IMT) was thickening and multiple plaques had formed and lesionsinvolving lumen result in stenosis. CT reconstruction showed the whole aorta wasaffected by dysplasia and stenosis. Coronary arteriography showed main coronaryartery was irregular and stenosis.99Tcm-MIBI MPI performed in2012showeddilation of the heart at the left ventricular and myocardial ischemia aggravated.2D-STI showed strain of GLPS-Avg, GLPS-LAX, GLPS-A4C, GLPS-A2C planesare decreased. Transthoracic Doppler echocardiography (TTDE) dynamic detectedaorta stenosis gradually, increasing pressure difference (PG), enlarged left ventriclechamber, and more regurgitation of valves, it could also non-invasively andaccurately detected the position of atherosclerotic calcium and evaluate coronary flowhemodynamics. Analysis showed the patient had significantly lower coronary flowvelocity reserve due to plaques occluding coronary artery ostia. |
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