| Objective A systematic and holistic assessment of left and right ventricular function in patients with different segments of acute myocardial infarction was performed using strain and tissue mitral annular displacement parameters obtained by two-dimensional speckle tracking imaging.To evaluate subclinical cardiac dysfunction in patients with left ventricular ejection fraction preservation by strain and TMAD parameters.Auto-strain RV,an intelligent analysis software,was used to automatically evaluate the right ventricular strain and explore its clinical application value.Methods86 patients who were diagnosed as acute myocardial infarction(AMI)with single coronary artery stenosis >75% confirmed by coronary angiography were selected as the experimental group.Combined with ECG,ventricular wall motion score index and coronary angiography results,they were divided into anterior myocardial infarction group(Ant-MI group)and inferior myocardial infarction group(Inf-MI group).According to whether the left ventricular ejection fraction(LVEF)was reduced,they were divided into myocardial infarction with preserved ejection fraction group(p EF-MI group,LVEF>53%)and myocardial infarction with decreased ejection fraction group(d EF-MI group,LVEF ≤ 53%),and 34 healthy volunteers were enrolled as the control group.All subjects were examined by echocardiography.Routine ventricular systolic function parameters were measured,including left ventricular end-diastolic dimension(LVEDD),fraction of right ventricular area changes(FAC),left ventricular end-diastolic volume(LVEDV),tricuspid annular plane systolic excursion(TAPSE),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),tricuspid annular systolic peak velocity(S’).The left ventricular global longitudinal systolic strain(GLS),left ventricular global circumferential systolic strain(GCS),left ventricular global radial systolic strain(GRS)were calculated by 2D-STI.The right ventricular free wall longitudinal systolic strain(RVFWLS)and right ventricular global longitudinal systolic strain(RVGLS)were measured by Auto-strain RV software.Then the mean tissue mitral annular displacement(m TMAD),tissue mitral annular displacement of the middle point(TMAD mid)and left ventricular longitudinal fractional shortening(TMAD mid%)were assessed using TMAD.SPSS26.0 was applied to compare the differences of parameters in each group.Correlation analysis was performed between the GLS,TMAD parameters and LVEF.By drawing the receiver operative characteristic(ROC)curve,the optimal cutoff values of relevant parameters were obtained to evaluate the value of GLS and different TMAD parameters in predicting LVEF reduction in AMI patients.Bland-Altman analysis and intraclass correlation coefficient(ICC)were used to test the repeatability of intra-observer and inter-observer consistency.Results(1)Comparison of general clinical data : The systolic and diastolic blood pressure in AMI group was higher than that in the control group(all P<0.05),and there was no statistical difference in other clinical data(P>0.05).(2)Comparison of left ventricular ultrasound parameters : Compared with control group,the value of GLS,m TMAD,TMAD mid and TMAD mid% decreased in p EF-MI and d EF-MI groups(all P<0.05),but there were no statistical difference in GRS and GCS(all P>0.05),the value of LVEDD,LVEDV,LVESV and LVEF in p EF-MI group were not significantly different(all P>0.05),the value of LVEF decreased and the value of LVEDD,LVEDV and LVESV increased in d EF-MI group,the difference of which were statistically significant(all P<0.05);Compared with p EF-MI group,the value of LVEDD,LVEDV and LVESV increased and the value of LVEF,GLS,m TMAD,TMAD mid and TMAD mid% decreased in d EF-MI group,the difference of which were statistically significant(all P<0.05),but there were no statistical difference in GRS and GCS(all P>0.05).Compared with control group,the value of GLS,m TMAD,TMAD mid and TMAD mid% decreased in Ant-MI and Inf-MI groups,the difference of which were statistically significant(all P<0.05),while there were no statistical difference in GRS and GCS(all P>0.05),Compared with Inf-MI group,the value of GLS,m TMAD,TMAD mid and TMAD mid% decreased in Ant-MI group,the difference of which were statistically significant(all P<0.05),while there were no statistical difference in GRS and GCS(all P>0.05).(3)Comparison of right ventricular ultrasound parameters : Compared with control group,there were no statistical difference in p EF-MI group’s parameters(all P>0.05);Compared with control and p EF-MI groups,the value of RVFWLS and RVGLS decreased in d EF-MI group,the difference of which were statistically significant(all P<0.05),but there were no statistical difference in RVD,RVOTD,TAPSE,S’ and FAC(all P>0.05).Compared with control group,the value of RVFWLS and RVGLS decreased in Ant-MI and Inf-MI groups,the difference of which were statistically significant(all P<0.05),but there were no statistical difference in TAPSE,S’and FAC(all P>0.05);Compared with Ant-MI group,the value of RVFWLS and RVGLS decreased in Inf-MI group,the difference of which were statistically significant(all P<0.05),but there were no statistical difference in TAPSE,S’ and FAC(all P>0.05).(4)Correlation analysis : The absolute value of GLS in AMI group was positively correlated with LVEF(r=0.770,P<0.001),and the value of m TMAD、TMAD mid、TMAD mid% were all positively correlated with LVEF(r=0.644、0.649、0.719,all P<0.001),and the absolute value of GLS was positively correlated with m TMAD、TMAD mid、TMAD mid%(r=0.508、0.510、0.539,all P<0.001).(5)ROC curve analysis:The AUC of GLS was 0.903 with the cutoff value of-12.5%(sensitivity 78.6% and specificity 87.9%).The AUC of TMAD mid% was0.919 which was the largest in TMAD parameters,with the cutoff value of 10.9%(sensitivity 96.4% and specificity 75.9%).(6)Repeatability test: The intra-observer ICC values of GLS,m TMAD,TMAD mid,TMAD mid%,RVFWLS,and RVGLS were 0.88,0.84,0.81,0.93,0.95,and 0.80 respectively,and the inter-observer ICC values were 0.81,0.85,0.79,0.94,0.92,and 0.82,respectively.Conclusion(1)The longitudinal strain and TMAD parameters obtained by 2D-STI have strong sensitivity to the early changes of ventricular systolic function after myocardial infarction,and they are easy to operate with good repeatability.It has a good application prospect for patients with LVEF preservation.(2)Compared with Ant-MI group,there was a greater impact in Inf-MI group on the right ventricular overall systolic function.The value of RVFWLS can evaluate the early right ventricular systolic dysfunction,which is of great significance for monitoring the changes of right ventricular function in patients with myocardial infarction.(3)There are good correlations between the longitudinal strain and TMAD parameters obtained by 2D-STI technology and the conventional echocardiographic parameters.They can be combined to estimate the ventricular systolic function of patients with acute anterior and inferior myocardial infarction.TMAD parameters have good diagnostic efficacy in predicting the reduction of LVEF after myocardial infarction.The AUC of TMAD mid% is 0.919 which is the largest in TMAD parameters. |
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