| Background and objectiveCoronary artery heart disease (CAD) is short for coronary artery disease, which is a common type of heart disease. CAD indicate coronary artery stenosis, coronary ischemia, which caused myocardial dysfunction and (or) no organic pathologic changes in organs, so it is also called ischemic heart diseases. CAD is the results of multiple vessel diseases, but coronary atherosclerosis hold great majority (95%-99%). The disease causes have not been fully understood. But it is related with hypertension, hyperlipidemia, hyperviscosaemia, diabetes, low in endocrine function, older and so on. CAD is the biggest of diseases in proportional mortality indicators of the world's population. The incidence and mortality of CAD in our country, which is a kind of diseases of is rapidly rising in proportional mortality indicators in chinese residents. There were three methods to treat patients with CAD, which was medication, interventional therapy and surgical therapy according to the specific condition in present. Percutaneous coronary intervention (PCI) was used in patients in 1977. After thirty years of rapid development, PCI was a most mature and most promising technology. And its outstanding advantages were the low trauma, low risk, high curative effect. Coronary interention using modern high-tech means for the disease were micro invasion therapy, it was guided in the high-end medical imaging equipment, through precision instruments' guidance of the catheter, wire, balloon, stent, special. A fews of treatments were used to dredged the narrowing or occluded coronary artery. There were something about changes of left ventricular configuration needing advanced research pre- and post- PCI, including structure, systolic function,diastolic function, ventricular synchronism. The methods of evaluating cardiac function by echocardiography in patients with PCI consisted of two-dimensional echocardiography (2DE), spectra and colour Doppler echocardiography, acoustic quantitative technique (AQ), Doppler tissue imaging (DTI), real-time three-dimensional echocardiography (RT3DE). RT3DE is an important technical breakthrough in ultrasonic imaging field, which could get imagings to research in every aspects.RT3DE could get true three-dimensional configuration of left ventricular chamber, without depending on the hypothesis of geometry.RT3DE obtain major scope of full volume heart structure stereo data, analyses the size, shape, function of cardiac chambers, supply a sort of feasible, simple new technique for appraise heart global function, segmental function as well as contraction synchronism. There was great value to quantitatively evaluate left ventricular configuration changes. There was little research about left ventricular remodeling and some early clinical laboratory index. Are there more strong relevance between RT3DE and Clinical biochemical indicators? This question need further study. The research preliminarily discussed the relationship between RT3DE parameters of the time to the point with minimal systolic volume (Tmsv) in 16 segments standard deviation and the maximal difference of time (Tmsv16-SD, Tmsv16-Dif) and the concentration of brain natriutrtic peptide (BNP) in blood plasma. So, this study measured the left ventricular series indices of the patients pre- and post- PCI and normal people by RT3DE and respectively compared one another. The purpose:①To analyze the left ventricular structure, systolic function, diastolic function, ventricular synchronism indices by RT3DE, to compared with normal control and to discuss left ventricular remodeling. ②To evaluate the changs of left ventricular structure, systolic function, diastolic function, ventricular synchronism indices after PCI, meanwhile, compared with pre-PCI. To detect the reverse remodeling characteristics of left ventricular.③To approach the relations of RT3DE parameters(Tmsvl6-SD,Tmsv16-Dif)) and the concentration of BNP and also to discuss clinical values.Materials and methodsTo collect 57 patients who visited Henan Provincial People's Hospital as research object from October,2009 to July,2010. The normal control group included 27 normal people (mean age 52.00±12.25,23 men and 4 women).There were no abnormal findings in physical examintion and other auxiliary examinations. The coronary artery disease group included 30 patients(mean age 56.42±13.06,25 men and 5 women).Acute myocardial infarction occupied 19 cases, including anterior wall, widely anterior wall, inferior wall corresponding respectively 10 cases,7cases,2case. Old myocardial infarction occupied 11 cases, including anterior wall, inferior wall corresponding respectively 5 cases,6cases. One branch or multivessel coronary artery stenosis rate>75 confirmed by coronary angiography. All coronary artery disease patients carried out PCI after in stable condition, average 7.2±3.2 days in hospital. All cases were examined by RT3DE pre- and 1 month post- PCI. The exclusion criterion: poor in imaging quantity, all kinds of cardiac arrhythmia and abnormal conduction, valve stenosis and(or) moderate or severe valve regurgitation, Congenital heart disease, severe hypertension diseases and so on. Using Philips iE 33 colour Doppler ultrasonic instrument, equipped with X3-lmatrix triaxiality probe, frequency 1～3MHz. start-up. The subjects were taken left lateral position, connected electrocardiography, put triaxiality probe to the apex of heart, after acquired satisfied cardiac apical four-chamber view imaging to breathless after exhale end, acquired the full volume imaging mode. The instrument automatically builted "pyramid" contains inside left ventricular by RT3DE. The pictures were sent to workstation. Opened Qlab 4.2 quantitative analysis software in the workstation. After selected five endocardium sample point of four-chamber view mitral valve loop level, two-chamber view mitral valve loop level and cardiac apex, then software traced out dynamic triaxiality endocardium outline automatically. It proceeded to sequential analysis offline, left ventricular end-diastolic volume(EDV), end-systolic volume (ESV), ejection fraction (EF), the peak ejection rate (PER), peak filling rate(PFR),the time to the point with minimal systolic volume(Tmsv) in 16 segments standard deviation and the maximal difference of time(Tmsv16-SD, Tmsvl6-Dif) separately.17 segments volume-time curves database were obtained by QLab software, figured out peak ejection rate (PER= dv/dt min/EDV), peak filling rate (PFR=dv/dt max/EDV). Because of heart rate differently in subjects and to make the data more comparability, divided by each of the cardiac cycle time (R-Rinterphase) in examination. So we got Tmsvl6-SD%,Tmsv16-Dif%.Results1. Compared with control group by RT3DE parameters:end-diastolic left ventricular volume (EDV), end-systolic volume(ESV), the time to the point with minimal systolic volume (Tmsv) in 16 segments standard deviation and the maximal difference of time (Tmsv16-SD, Tmsv16-Dif), Tmsv16-SD%,Tmsv16-Dif% were significantly increased, left ventricular ejection fraction (LVEF), peak ejection rate (PER), peak early filling rate(PFR) in CAD patients were significantly decreased (P<0.01).2. Compared with pre- and post-operation:The left ventricular EDV, ESV, Tmsv16-SD, Tmsvl6-Dif, Tmsv16-SD%,Tmsv16-Dif% were significantly decreased (P<0.01), meanwhile EF, PER, PFR were significantly increased(P< 0.01).3. In patients group, Linear correlative analysis showed that Tmsv16-SD, Tmsv 16-Dif had highly correlated with biochemical indicator BNP. (r=0.874,0.862, <0.01).Conclusion1. Left ventricular remodeling occurred in patients with myocardial infarction.It could be quantitative assessment left ventricular remodeling of patients with coronary artery disease by RT3DE. 2. PCI can reverse LV remodeling. The function and struction of left ventricular reverse remodeling can be accurately evaluated by RT-3D in CAD post-PCI.3. In patients group, Linear correlative analysis showed that Tmsvl6-SD, Tmsv16-Dif had highly correlated with biochemical indicator BNP, which meant Tmsv16-SD, Tmsv16-Dif by RT3DE could reflect the variance of left ventricular remodeling. |
PDF Full Text Request