Assessment Of Right Ventricular Function By Two-dimension Speckle Tracking In Patients With Coronary Disease

BackgroundFor a long time, coronary heart disease (CHD) research is given priority to with the left ventricle (LV). Despite the clinical observation of right ventricular (RV) infarction almost80years ago, this condition had received little clinical attention until recent years, as early animal studies suggested it to be of low haemodynamic significance. On the other hand also because of the RV complex geometry and unique physiological structure characteristics lead to assess methodological limits. But with the deepening of the research on CHD, RV in the circulatory system can not be ignored the role of more and more attention.Two-dimensional speckle tracking imaging (STI) is a novel Doppler-independent techniques to obtain these measurements of myocardial movement and deformation. Standard grey scale images are analysed with a dedicated software package that focuses on specific speckle patterns and follows them on a frame-by-frame basis during a cardiac cycle. While this method has been frequently used to assess LV function, it has yet rarely been used to examine RV function.The aim of this study is to quantitative evaluation of RV function in patients with CHD by STI, and to provide basis for clinical early diagnosis and treatment.Part1Two-dimension speckle tracking assessment of right ventricle function in patients with acute inferior myocardial infarction and after percutaneous coronary interventionsObjective This study was to evaluate the usefulness of STI for assessment of systemic RV function in patients with acute inferior myocardial infarction and the changes7days,1month and3months after percutaneous coronary interventions (PCI)Methods40cases of patients with acute inferior wall myocardial infarction were evaluated RV function quantitatively. On two-dimensional echocardiographic left heart long axis plane and apical four-chamber view measurement parameters are as follows: left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), right ventricular end systolic diameter (RVESD) and right ventricular end diastolic diameter (RVEDD). Pulmonary artery pressure (PAP) was estimated from the tricuspid valve (TRV) using the Bernoulli equation in patients with TRV regurgitation. LVEF was calculated according to the modified Simpson’s rule using the apical four-and two-chamber views. At least three cardiac cycles were digitally stored for offline analyses. The endocardial border was manually drawn by the operator during end-systole. In the apical four-chamber view, the RV myocardium was then automatically divided into six segments (basal, mid, and apical segment of the septum and the RV free wall) after manually drawing the endocardium of the right ventricle. Thirty of the remaining forty patients underwent emergency PCI within the first twelve hours of symptom onset and were finally enrolled in the study. Fifty age-and sex-matched adults as controls.Result The strain (S) values in the base and mid segmental of RV free wall and all segments of right septum were significantly lower in patients with acute inferior myocardial infarction (P<0.05). But the strain rate (Sr) values only decreased in mid segment of right septum. Except the apical parts of RV free wall and right septum, the S values of others segmental were significantly improved (P<0.05)7days after PCI. But the Sr values have no changes (P>0.05).One month after PCI, the S values in the base and mid segmental of free wall and all segments of right septum were significantly improved (P<0.05). The Sr values in the mid of septum was increased (P<0.05). And after3months, all the damaged segmental S values were further improved (P<0.01).Consult STI is a new and useful technology for quantitative assessment of RV function in acute inferior MI and PCI after7days,1month and3month the damaged section strain values were restored. Part2Two-dimension speckle tracking assessment of left and right ventricular functions in patients with isolated disease of right coronary arteryObjective This study was to evaluate the usefulness of STI for assessment of left ventricle (LV) and right ventricle (RV) functions in patients with isolated disease of right coronary artery.Methods45cases were diagnosed as single right coronary lesions given echocardiography,30cases had chest pain but coronary angiography has not seen the obvious narrow as a comparison. LVESD, LVEDD, RVESD and RVEDD were measured on two-dimensional echocardiographic left heart long axis plane and apex four-chamber view. LVEF was calculated according to the modified Simpson’s rule using the apical four-and two-chamber views. At least three cardiac cycles were digitally stored for offline analyses. The two-dimensional loop-cinec were obtained in apical four-chamber view, apical two-chamber view and long axis of left ventricle view. Eighteen segments of LV longitudinal peak systolic strain, global peak systolic strain of each view were measured by software of two-dimensional strain. In the apical four-chamber view, the RV free wall myocardium was then automatically divided into three segments (basal, mid, and apical) after manually drawing the endocardium of the right ventricle.Result Compared with the controls, the patients who had right coronary lesions but did not happen myocardial infarction, the strain (S) values in the base, mid and apex segmental of LV post wall, the base and mid segmental of LV inferior wall and the base and mid segmental of LV septum were significantly lower (P<0.05); the S values in the mid segment of RV free wall was lower (P<0.05). Compared with the controls, the patients who had right coronary lesions and acute myocardial infarction, the S values in the base, mid segmental of LV antsept, the apex segmental of LV anterior wall, the base, mid and apex segmental of LV post wall, the base and mid segmental of LV inferior wall and the base and mid segmental of LV septum were significantly lower (P<0.05); the S values in the mid and apex segments of RV free wall were lower (P<0.05). And the LV global longitudinal strains were lower in the two groups (P<0.05). Compared with none infarction group, the S values in the mid and apex segments of RV free wall were obviously reduced in patients with right coronary stenosis and acute myocardial infarction (P<0.05); basal segments of posterior and inferior of LV and the whole left ventricular strain values were decreased(P<0.05).Consult STI is a new and useful technology for assessment ventricular functions in patients with isolated disease of right coronary artery, and there were multiple segments impaired both in LV and RV. Part3Two-dimension speckle tracking assessment of right ventricle in patients with acute anterior myocardial infarction and in patients with acute inferior myocardial infarctionObjective This study was to assessment of systemic right ventricle (RV) function in patients with acute anterior myocardial infarction and in patients with acute inferior myocardial infarction, and to compare the RV functions after different left ventricular walls infarction.Methods56cases were diagnosed with acute myocardial infarction for the first time by ECG and myocardial enzyme spectrum given echocardiography. There were29cases of anterior wall infarction,27patients with inferior wall infarction. LVESD, LVEDD, RVESD and RVEDD were measured on two-dimensional echocardiographic left heart long axis plane and apex four-chamber view. LVEF was calculated according to the modified Simpson’s rule using the apical four-and two-chamber views. In the apical four-chamber view, the RV myocardium was then automatically divided into six segments (basal, mid, and apical segment of the septum and the RV free wall) after manually drawing the endocardium of the right ventricle.Result Compared with controls, the strain (S) values in the all segments of RV were significantly lower in patients with acute anterior myocardial infarction (P<0.05) Except the apical parts of RV free wall, the S values of others segmental were significantly lower in patients with acute inferior myocardial infarction (P<0.05). But there was no significant difference of all the variables between the two myocardial infarction groups.(P>0.05)Consult RV regional S values were reduced both in patients with anterior myocardial infarction and in patients with inferior myocardial infarction. And the S values of them have no significant difference.