Non-invasive Evaluation Of Left Ventricular Myocardial Work In Patients With Different Degrees Of Coronary Artery Stenosis

Objective:Non-invasive quantitative evaluation of left ventricular global myocardial work(MW)in patients with different degrees of coronary artery stenosis by echocardiography,To explore the relationship between the changes of MW related parameters and the degree of coronary artery stenosis and the clinical value of this technique in the diagnosis of coronary artery stenosis.Methods:From November 2019 to October 2020,99 patients with suspected coronary heart disease(CHD)who underwent coronary angiography in our hospital were selected.According to the results of coronary angiography,the patients were divided into four groups:normal group(25 cases,without obvious coronary arteries stenosis),non-severe stenosis group(26 cases,coronary artery stenosis rate<70%),single severe coronary artery stenosis group(24 cases,with and only one coronary artery stenosis rate>70%)and multiple severe coronary artery stenosis group(24 cases,with two or more coronary artery stenosis rate>70%).Routine echocardiography and required image acquisition were completed within 24 hours before the coronary angiography examination,and the height,weight,blood pressure and other parameters of all patients were measured.Then the image is imported into Echo pac 203 workstation for offline analysis of global longitudinal strain(GLS),peak strain dispersion index(PSD),and MW related parameters,such as global work index(GWI),global useful work(GCW),global reactive work(GWW),global work efficiency(GWE).Finally,all the data are statistically analyzed and compared.Results:(1)Compared with the normal coronary artery group,the PSD,GLS and GWW of the non-severe stenosis group,the single-vessel severe stenosis group and the multiple-vessel severe stenosis group have different degrees of increase,while GWI,GCW and GWE have different degrees.Decrease,the results are statistically significant(p<0.05).Among them,the difference between the groups of GWE is more obvious(p<0.01).The PSD and GWW of the non-severe stenosis group and the single-vessel severe stenosis group were higher than the normal group(p<0.05),and the GWE of the normal group was significantly lower(p<0.01).Compared with the normal group,non-severe stenosis group,and single-vessel severe stenosis group,the GLS and GWW of the multiple-vessel severe stenosis group were increased,and GWE were all decreased,especially compared with the normal group and the non-severe stenosis group,there were significant statistical differences(p<0.01).The PSD of the multiple-vessel severe stenosis group was higher than that of the other three groups(p<0.05),and the difference was particularly significant compared with the normal group(p<0.01),and the GWI of the multiple-vessel severe stenosis group was comparable to that of the normal group and the non-severe stenosis group.The ratio also decreased to a certain extent,and the differences were statistically significant(p<0.05).(2)SBP is positively correlated with GWI,GCW,and GWW to varying degrees(p<0.01);LVEF is positively correlated with GWE,and PSD is negatively correlated with GWE(p<0.05);LVEF is negatively correlated with GWW,and PSD is negatively correlated with GWE GWW was positively correlated(all p<0.01);GLS had a good correlation with MW parameters,positively correlated with GWW,and negatively correlated with GWE,GWI and GCW(all p<0.01).(3)Taking GWW>89mmHg%as the cutoff value,the AUC for predicting coronary artery stenosis is 0.868(p<0.01),the sensitivity is 0.824,and the specificity is 0.800,which is better than GLS(AUC=0.746,p<0.01);Taking GWW>126.5mmHg as the cutoff value,the AUC for predicting severe coronary stenosis is 0.825(p<0.01),the sensitivity is 0.792,and the specificity is 0.824,which is also better than GLS(AUC=0.772,p<0.01).(4)The measurement repeatability of data values between observers and within observers is good.Conclusion:1.When coronary artery stenosis occurs,the decrease of perfusion leads to the disturbance of myocardial metabolism and the change of left ventricular function,which leads to the increase of GWW and the decrease of GWE.2.GWW can be used as a sensitive index to predict coronary artery stenosis and severe coronary artery stenosis,and its value is better than GLS and other overall MW parameters.3.As a new non-invasive,simple and repeatable technique,non-invasive MW provides a new and effective reference index for the evaluation of left ventricular function in patients with coronary artery stenosis.