Assessment Of Regional Left Ventricular Wall Motion By Speckle Tracking Imaging And Anatomic M-mode Echocardiography

Background Quantitative diagnosis of myocardial ischemia and myocardial infarction (MI) with accuracy is meaningful to the estimation of the severity, prognosis and efficacy of coronary heart disease (CHD). There are multiple imaging modalities of echocardiography to assess the global function and wall motion of left ventricle in patients with CHD quantitatively, however, the new imaging modalities of echocardiography lack of systematic and further study in the regional motion of left ventricle.Objectives 1. To investigate a non-invasive way to assess regional left ventricular wall motion by speckle tracking imaging (STI) and anatomic M-mode Echocardiography (AMM). 2. To determine the values of STI and AMM in estimating the regional motion of left ventricle in patients with CHD.Methods According to the foundings of CAG, the subjects were divided into three groups:40 healthy persons who did not have coronary artery stenosis and abnormal TIMI flow checked by CAG and other disease were enrolled as normal controls(NOR group), with 27 males, 13 females and the average age of 48.3 years old; 60 patients who had more than one main coronary artery stenosis (≥50%) but did not have MI were selected as group B, coronary heart disease group (CHD group), with 36 males, 24 females and the average age of 60.6 years old; 32 patents with affirmative MI(including acute, subacute and old MI) were enrolled in group C, myocardial infarction group (MI group), with 23 males, 9 females and the average age of 62.3 years old.The measurement of indexes of STI: Record high frame frequency images of apical four chamber view, two chamber view and left ventricular long-axis respectively, and measure the two-dimensional strain (2DS)-peak systolicn strain(PSS)of anterior septal of left ventricle, anterior wall, lateral wall, posterior wall, inferior wall and posterior septal by 2DS software. The measurement of indexes of AMM: Gauge the wall thickness of anterior septal of left ventricle, anterior wall, lateral wall, posterior wall, inferior wall and posterior septal in the stage of end-diastolic and end-systolic from three level of the short axis of left ventricle, then calculate the wall thickening fraction(WTF). Results1. STI for assessment the regional motion of the left ventricle.There were 292 abnormal segments in CHD group, the sensitivity was 58.60%; the specificity was 85.96%;there were 302 abnormal segments in MI group, the sensitivity was 87.79%. the specificity was 76.79%; The segments with PSS>0 were 64, the percentage of lesion was7.55%. Compared to the NOR group, the left ventricular peak longitudinal strain PSS were lower(p<0.01) in MI group and CHD group during systole. Compared to the CHD group, PSS was lower(p<0.01) in MI group during systole. The results have statistically significant differences.2. AMM for assessment the regional motion of the left ventricle.There were 272 abnormal segments in CHD group, the sensitivity was 54.84%; the specificity was 84.93%; there were 284 abnormal segments in MI group, the sensitivity was 84.52%. the specificity was 84.82%; The segments with PSS>0 were 64, the percentage of lesion was also 7.55%, consistent with the STI results.The regional ventricular WTF were lower in MI group(p<0.01) and CHD group(p<0.05). Compared to the CHD group, WTF was lower in MI group(p<0.01). The results have statistically differences, but the difference between CHD group and Nor group was not as significant as STI.Conclusions1. Both STI and AMM could quantitatively and accurately analysis the regional ventricular wall motion.2. Both STI and AMM could sensitively and specifically detect the ischemic segments of left ventricle in CHD or MI patients.3. Either STI or AMM was a flexible, practical and convenient method for evaluating the left ventricular wall motion in CHD or MI patients.