| ObjectiveTo evaluate the accuracy and reproducibility of the “ heart model ”automated software(HM)in quantifying the left heart chamber volumes and function in patients with coronary atherosclerotic heart disease(CAD)with different lesions,and explore the necessity of manual correction for accurate measurement of left ventricular function in CAD patients.To evaluate left ventricular volumes and function of CAD patients in different groups and analyze the connection between those parameters and the degree of coronary disease,taken the manual-three-dimensional echocardiography(M-3DE)as a reference.MethodsEighty subjects were enrolled in this study.According to the Gensini score,patients were divided into mild disease group(1-27 points),moderate disease group(28-50 points),severe disease group(>50 points)and normal control group(0 points).20 subjects were obtained in each group separately.Left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),left ventricular ejection fraction(LVEF)and the maximum volume of the left atrium(LAVmax)were measured respectively using HM with or without regional editing(HM-RE、HM-NE)and M-3DE.The correlation analysis and consistency test for the measurements of HM-NE and HM-RE were evaluated,taken M-3DE as the relative standard.The differences of measurements and analysis time among three methods were compared.The intra-observer and inter-observer repeatability of the three techniques were compared.The correlation between Gensini score and each parameter obtained by the three methods were analyzed.Used M-3DE as the standard,the grading differences of LVEF measured by HM-RE and HM-NE were compared.The receiver operating curve(ROC)of left ventricular volume parameters(LVEDV,LVESV)for predicting severe coronary artery disease(>50 points)was drawn.Results(1)HM is a highly feasible technique for analyzing the left heart chamber volumes and function in patients with CAD,whose success rate up to 94%.(2)The left ventricular function parameters measured by HM-NE,HM-RE and M-3DE showed the same trend in CAD patients with different degree.Compared with the normal control group,the left heart chamber volumes increased significantly and LVEF decreased significantly in the disease groups(P<0.01).With the increase of the disease degree,LVEDV,LVESV and LAVmax increased gradually and LVEF decreased gradually(P<0.05).HM-NE and HM-RE parameters have good correlation and consistency with M-3DE parameters.Except for LVEF,the measurements obtained by HM-NE and HM-RE are greater than those of M-3DE in each group(P<0.05).(4)HM-NE and HM-RE got the higher repeatability(ICC: 0.89-0.99)and the less analysis time(P<0.01)than M-3DE.(5)The LVEF classification differed in only 1 case between HM-RE and M-3DE,while HM-NE underestimated the LVEF in 9 patients.(6)Among the three methods,the parameters of HM-RE showed the highest correlation with Gensini score(|r|: 0.70～0.87).When the value of LVESV measured by HM-RE was up to 59.25 ml,the best cut-off volume for predicting the severe coronary artery diseases would be gotten(sensitivity90%,specificity 91%).Conclusions(1)HM is a highly feasible and time-consuming technique in quantification of the left heart chamber volumes and function in patients with CAD.It not only has good correlation with M-3DE,but also has high accuracy and repeatability.It is expected that this automated method would replace M-3DE as the first choice in evaluating the left heart chamber volumes and function in the future.(2)HM gives the accurate reflection about the changes of left heart chamber volumes and function in patients with different coronary disease severity.(3)It’s necessary for adjusting the endocardial boundary to improve the accuracy of the measurements,especially in patients with moderate or severe coronary disease.(4)The measurements of HM-RE have a good correlation with Gensini score.When the value of LVESV measured by HM-RE was 59.25 ml,there was an indication of severe coronary artery stenosis which deserves to be a clinical index to patients for preoperative evaluation and postoperative follow-up. |
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