| Objective: Two dimensional echocardiography (2DE) is a non-invasive,simple, intuitive, inexpensive imaging examination method, which has beenwidely used in the clinical diagnosis and treatment of heart disease. coronaryartery lesions and diagnose coronary heart disease (CHD). A lot of basic andclinical studies have shown that the regional wall motion abnormality(RWMA) detected by echocardiography can be used to predict coronary arterystenosis, especially of high degree with high specificity. However, there ismuch less clinical study of2DE on the subject. In this study,the results of2DE and CAG from the patients with the clinical suspected diagnosis ofunstable angina were analyzed to explore the predictive value in coronaryartery stenosis and its influencing factors.Methods:173cases of patients (79males,94females；age31-80years,average age62±9years),who were in hospital from March2010to August2010with the diagnosis of the clinical suspected diagnosis of unstable angina,were studied. They were examined with both2DE and CAG at the sameperiod respectively in two weeks(2DE followed by CAG). Criteria forexclusion included advanced people(>80years), acute or old myocardialinfarction, severe bradycardia or tachycardia, complete left bundle branchblock, severe lesions of mitral valve or aortic valve, severe heartfailure(NYHA Ⅲ-Ⅳ), all kinds of cardiomyopathy, congenitalcardiovascular disease,anomalous origin of coronary artery, triple diffusevessel lesion, severe left main lesion, chronic total occlusion, coronary arterymyocardial bridge. The RWMA detected by echocardiography was visuallyanalyzed by using the method of16segments recommend by the AmericanSociety of Echocardiography (ASE). The results included hypokinetic, akinetic, dyskinetic.The coronary vessels with the diameter more than2mmwere evaluated according to the coronary artery segments classification of theAmerican Heart Association (AHA). The coronary artery stenosis grading:(1)normal;(2)mild stenosis: the degree of lumen diameter reduction<50%;(3)moderate stenosis: the degree of luminal diameter reduction≥50%but<75%;(4)severe stenosis: the degree of luminal diameter reduction≥75%. If anyvessel segment of the coronary artery had moderate or severe stenosis,thepatient was diagnosed as CHD, which were classified into single-vesseldisease, double-vessel disease and triple-vessel disease according to thenumber of lesion vessel.Multiple vessel disease included double-vessel diseaseand triple-vessel disease.If the RWMA was in accordance with the standardarea that pathological vessel dominate, the coincidence betweenechocardiography and CAG was confirmed. The diagnostic accuracy of2DEwas expressed as sensitivity, specificity, positive and negative predictive value.The influencing factors of the RWMA detection were analyzed.Results:134cases had been detected RWMA (15kinds of results) among173patients. The positive results were all hypokinetic.2Among the coronary artery segments (vessel diameter≥2mm) of173cases, there were198segments with stenosis lesions (100segments of LAD,54segments of RCA,44segments of LCX).The segments with the luminaldiameter reduction≥50%,of which stenosis degree≥75%were46.46percent(92/198), counted69.70percent of total lesion segments (138/198). Accordingto the stenosis degree of coronary artery, the patients were divided into:54cases of normal group,31cases of mild stenosis group,22cases of moderatestenosis group,66cases of severe stenosis group. The CHD patients weredivided into:51cases with single-vessel disease,24cases with double-vesseldisease,13cases with triple-vessel disease.3According to the stenosis degree of coronary artery, the positive caseswere divided into:7cases of normal,4cases of mild stenosis,1case ofmoderate stenosis,22cases of severe stenosis. Two cases of RWMA (hypokinetic in anterior part of interventricular septum and anterior part of leftventricle) were not in accordance with the standard area that pathologicalvessel dominate. So they were regarded as negative results. There wasstatistically significant difference of2DE results between stenosis group andnormal group diagnosed by CAG(P＜0.05). The sensitivity, specificity,positive and negative predictive value of2DE was21.01%(25/119),87.04%(47/54),78.13%(25/32),33.33%(47/141). There was statisticallysignificant difference of2DE results between CHD group and not CHD group(P＜0.05). The sensitivity, specificity, positive and negative predictive value,accuracy of2DE was23.86%(21/88),87.06%(74/85),65.63%(21/32),52.48%(74/141),54.91%(95/173). There was statistically significantdifference of2DE results between severe stenosis group and the other stenosisgroup (including mild and moderate stenosis group) diagnosed byCAG(P=0.006＜0.05). The sensitivity, specificity was30.30%(20/66),90.57%(48/53). The positive results of the CHD patients were divided into:8cases in single-vessel disease group,8cases in double-vessel disease group,5cases in triple-vessel disease group. The positive rate of RWMA separatelywas: single-vessel disease15.69%(8/51), double-vessel disease33.33%(8/24),triple-vessel disease38.46%(5/13). There was statistically significantdifference of2DE results between multiple-vessel disease group andsingle-vessel disease group(P=0.035＜0.05).Conclusion:12DE has a high specificity, and a low sensitivity. The omission diagnosticrate is high to the pathological coronary artery with low stenosis degree orsmall dominated area. All the influencing factors should be considered in theclinical work.2A variety of factors have influence on the RWMA detection of CHD,including of the stenosis degree of coronary arteries, the number ofpathological vessels, and the site of lesions,etc. |
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