The Clinical Study Of Assessment Of Left Ventricular Function In Patients With Successful Coronary Revascularization By Doppler Tissue Imaging

Object: The purpose of this study was to assess the changes of left ventricular function before and 1 week, 3 month, 6 month after Coronary artery bypass grafting (CABG) or Percutaneous coronary intervention (PCI) with Doppler tissue imaging (DTI) and 2D echocardiography. To evaluate the clinical value of DTI , we compared the differents of these two technology of echocardiography. Meanwhile we observed the effects of Coronary revascularization (CRV) on left ventricular function.Material and Methods: 166 patients (mean age 57.02 + 10.14 years ) male (152) female (14) were enrolled in this study . 88 patients received CABG and 78 patients received PCI. There were 21 patients with anterior wall myocardial infarction and 24 patients with inferior wall myocardial infarction in the group of CABG. All of the patients had accepted coronary angiography and gained successful Coronary revascularization. Patients with valvular heart disease, cardiomyopathy and congenital heart disease were excluded. Each examination consisted of M mode, two-dimensional echocardiography (2DE), pulsed-wave Doppler blood flow and pulsed DTI measurements. The left ventricular ejection fraction (EF), peak E peak A wave velocity and peak E versus peak A (E/A) were recorded. The velocity of systolic wave (s), early diastolic filling wave (e), late filling wave (a) and wave e versus wave a (e/a) were measured by DTI at the septal anterior inferior and lateral late point of mitral annular. Results: The 2D echocardiography examination showed that the left ventricular EF was remarkably increased after 3 to 6 month of CRV (p < 0.05 ), but it was not significantly change 1 week after CRV ( p >0.05 ). The average velocity of systolic wave (s) of mitral annular wasremarkably increased from 1 week after CRV in both of CABG andPCI ( CABG : p <0.05 and PCI: p O.0001 ). S wave was relatedto LVEF. But the sensitivity of s wave is better than LVEF's. Therewere no different in the pulse Doppler transmitral flow velocity E/Abefore and after CRV ( p > 0.05 ) . But the average velocity of mitralannular (e/a) was remarkably increased from 1 week after CRV ( p0.0001 ). In the patients with inferior wall myocardial infarction,the velocity of inferior regional wall ( s and e/a ) was remarkablyincreased after CABG ( p<0.0001 ). But EF and E/A were notsignificantly different after CABG. In the patients with anterior wallmyocardial infarction, the velocity of anterior regional wall ( s and e/a)was remarkably increased after CABG ( p <0.05 ). The EF wasdecreased at 1 week and increased 6 month after CABG ( p <0.05 ) butE/A were not significantly different after CABG .Conclusions: The results of this study suggested that the global leftventricular systolic and diastolic function in CAD patients wasimproved after CRV and the function of the regional wall with MIwas improved from 1 week after CRV, which could be detected withDTI before the global function improved. This study alsodemonstrated that DTI could provide a more sensitive method todetect the cardiac function of CAD and CRV is one of the importantfactors for the cardiac function improvement in patients withCAD.