Evaluation Of Left Ventricular Myocardium Function In Patients With Multi-vessel Coronary Artery Disease By Anatomical M-type And Two-dimensional Speckle Tracking Imaging

Objective: To evaluate the left ventricular myocardium function in patients with multi-vessel coronary artery disease by anatomical M-type and two-dimensional speckle tracking imaging.Methods: Thirty-eight multi-vessel coronary artery disease patients(MVD)with normal wall motion and forty subjects with normal coronary artery as control group were enrolled in this study.The apical four-chamber view,two-chamber view and long-axis view of the left ventricular were recorded by using two-dimensional echocardiography(2DE).Left ventricular parameters were measured by two-dimensional echocardiography(2DE),anatomical M-type(AMM)and two-dimensional speckle tracking imaging(2D-STI)respectively in both groups:1.Routine parameters measured by two-dimensional echocardiography(2DE)included: left ventricular end-diastolic diameter(LVDd),left atrial end-diastolic diameter(LAESd),end-diastolic ventricular septal thickness(IVSTd),end-diastolic left ventricular posterior wall thickness(PWTd)and E/A,E/e.Left ventricular ejection fraction(LVEF)were measured by the method of biplane Simpson.2.Left ventricular systolic were evaluated by two-dimensional speckle tracking imaging(2D-STI)further:(1)Global and regional longitudinal systolic peak strain(GLS)were measured by automatic functional imaging(AFI)analysis software.(2)And then peak systolic longitudinal strain with layers were measured in the end-myocardium(LSendo),mid-myocardium(LSmid),epi-myocardium(LSepi)respectively.3.Left ventricular diastolic function were evaluated by 2D-STI and anatomical M-type(AMM)further:(1)The early longitudinal strain rate(SrE)and late longitudinal strain rate(SrA)of diastolic phase were recorded to calculate SrE/ SrA of each segment.(2)And then wall motion amplitude,systolic peak time,diastolic relaxation time,systolic peak time and diastolic relaxation time ratio of the interventricular septum,posterior wall,anterior wall and inferior wall were measured respectively.Results:1.The results of coronary angiography: Coronary angiography showed a significant increase in the number of collateral vessels in the the MVD group.2.The results of conventional parameters measured by two-dimensional echocardiography(2DE)were listed as follows:Compared with the control group,there were no significant differences in LVDd,IVSTd,LVPWTd,LAESd,E velocity,E/A,a velocity and LVEF(P >0.05),and significant differences in e velocity,A velocity and E/e(P<0.05).3.The results of left ventricular systolic function parameters measured by two-dimensional speckle tracking imaging(2D-STI)were listed as follow:(1)There was no statistically difference of GLS between the two groups(P >0.05).Compared with the control group,the longitudinal strain of septum and inferior wall in the base section and middle section were decreased in the MVD group,the differences have statistical significance(P<0.05).(2)The longitudinal strain of the endo-myocardium in the MVD group was significantly lower than that in the control group(P<0.05),but there was no significant difference in the longitudinal strain of the mid-myocardium and epi-myocardium(P >0.05).4.The results of left ventricular diastolic function parameters measured by 2D-STI and AMM were listed as follow:(1)There were significant differences in the SrE / SrA of partial segments between the two groups(P<0.05).(2)There were no significant differences in the amplitude of each motion and systolic peak time between the two groups(P >0.05).Compared with the control group,the diastolic relaxation time in the MVD group was prolonged,and the ratio of the systolic peak time to the diastolic relaxation time was decreased,the differences have statistical significance(P<0.05).Conclusion:1.Layer-specific strain by two-dimensional speckle tracking imaging can evaluate the longitudinal layered strain of multi-vessel coronary artery disease patients,and provide a new evaluation method to judge their early left ventricular systolic dysfunction.2.AMM combined with 2D-STI can evaluate the left ventricular diastolic function effectively in patients with multi-vessel coronary artery disease,which can help to simple and non-invasive screen out more multi-vessel coronary artery disease patients with no symptoms.