Left Ventricular Global And Regional Diastolic Function In Patients With Coronary Artery Stenosis But No RWMA

Coronary heart disease(CHD) caused by coronary artery stenosis or insufficiency blood supply, then myocardial function disorders and the emergence of organic disease occurrenced.1979 World Health Organization divided CHD into 5 clinical types: silent myocardial ischemia, angina pectoris, myocardial infarction, ischemic heart failure and sudden death. In recent years, the incidence of coronary heart disease showed a clear upward trend, seriously threat to the lives of patients. Therefore, early coronary artery disease detection, early treatment and regular follow-up are particularly important.The diagnosis of coronary heart disease are several ways:(1) coronary angiography and coronary enhanced CT: can clearly show the coronary artery lesions, but there is a clear nephrotoxicity from contrast agent, and does not apply to long-term follow-up;(2) ECG: some patients with angina only when the angina occurred,then ST segment changes, but non-specific, after remission, electrocardiogram returned to normal, so normal ECG does not exclude patients with coronary heart disease;(3) radionuclide: wall motion and left ventricular ejection fraction can be observed, but it needs high cost and radionuclides in the body has a greater damage;(4) MRI: good accuracy, high repeatability, but can not be observed in real time and bedside testing;(5)echocardiography, non-invasive, non-radiation, low cost, and can bedside testing, so it is more suitable for clinical use. Therefore echocardiography is an important role in patients with coronary artery disease. The first part Left ventricular global diastolic function in patients withcoronary artery stenosis but no regional wall motion abnormalityObjective:Appling real-time three-dimensional speckle tracking imaging(RT3D-STI) technique to obtain left ventricular global diastolic function index strain imaging(SI-DI), then evaluate left ventricular diastolic function in patients of no regional wall motion abnormality. Investigate the value of RT3D-STI in early diagnosis of CAD.Methods:According on coronary angiography(CAG), 92 patients of no regional wall motion abnormality were divided into two groups:control group,without coronary artery stenosis(n=21);case group,coronary stenosis group(n=50). The three-dimensional full volume dynamic images and two dimensional images of left ventricular were collected. Routine parameters EDV 、ESV etc and end-systolic left ventricular globle longitudinal strain(GLS), globle area strain(GAS), globle radial strain(GRS), globle circumferential strain(GCS) and corresponding strain imaging diastolic index(SI-DI), were aquired respectively. The parameters to diagnose coronary artery stenosis were analyzed.Results:Compared with control group,there were no significant difference in GLS, GRS, GAS and GCS(P>0.05). longitudinal SI-DI(L-SI-DI), radial SI-DI(R-SI-DI), circumferential SI-DI(C-SI-DI),area SI-DI(A-SI-DI) in case group were significantly reduced compared with control group(P<0.05).The sensitivity were 90.5%、85.7%、81.0%、81.0%, the specificity were 82.0%、68%、56%、78.0%,L-SI-DI was the best of specificity and sensitivity. L-SI-DI, R-SI-DI, A-SI-DI were significantly correlated with Gensini score( r =-0.706,-0.410,-0.547;P<0.05).Conclusion:The reduced of left ventricular diastolic function in patients of coronary artery stenosis more early than systolic function. RT-3D-STI was superior to conventional two-dimensional echocardiography, and can be quantitatively evaluated coronary stenosis.It is an important role in early diagnosis of coronary heart disease. The second part Left ventricular regional diastolic function in patientswith coronary artery stenosis but no regional wall motion abnormalityObjective:Acquired regional SI-DI, evaluate the left ventricular regional diastolic function in coronary heart disease( CHD) patients without RWMA by RT3D-STI,then investigate the value of RT3D-STI in detecting CHD.Methods:For 140 CAD patients have 420 coronary artery main branches. According on CAG, divided 420 coronary artery main branches into four groups: normal group, mild stenosis group, moderate stenosis group, sever stenosis group.The three-dimentional images of left ventricular were collected and analysis,then corresponding SI-DI were acquired respectively. The SI-DI by RT3D-STI to diagnose coronary heart disease were analyzed.Results:The longitudinal, radial,area SI-DI of mild stenosis group were lower than normal group; The all SI-DI and area strain(AS), longitudinal strain(LS) of moderate stenosis group were lower than normal group, AS and longitudinal,circumferential,area SI-DI were lower than mild stenosis group; AS, LS, circumferential strain(CS),radial strain(RS), the all SI-DI of sever stenosis group were lower than normal group and mild stenosis group, LS, RS,AS and longitudinal, radial, area SI-DI were lower than moderate stenosis group. The sensitivity of longitudinal SI-DI(84.0%) was the highest, the specificity of area SI-DI(78.9%) was the highest.Conclusion: RT3D-STI is an important role early discovery and diagnosis of coronary heart disease. The reduction of diastolic function in ischemic myocardium is early than systolic function. Diastolic function is more sensitive in ischemia, SI-DI can reflect coronary artery stenosis and location.