The Research On The Alterations Of Patients With Acute Coronary Syndrome Before And After PCI Using Echocardiography

BackgroundIn recent years, the morbidity and mortality of acute coronary syndrome (ACS) increased rapidly. Due to coronary plaque rupture or secondary thrombogenesis, coronary occlusion or spasm quickly, causing myocardial ischemia and hypoxia which can lead to arrhythmias, heart failure and even sudden death, severely affect quality of life, reduced longevity. Percutaneous coronary intervention (PCI) has become an important method for the treatment of coronary heart disease because it can relieve coronary stenosis and improve myocardial blood supply. But with the microcirculation dysfunction and reperfusion injury, the open artery theory has been questioned. Echocardiography can observe cardiac morphology dynamically and evaluate cardiac function noninvasively, now it has been applied in ACS diagnosis widely. Researches on the changes before and after PCI using echocardiography are most focused on systolic function in patients with acute myocardial infarction, few studies for acute coronary syndrome patients as well as diastolic function and overall functional changes, even there are more controversial results.ObjectiveIn this study, we use echocardiography evaluating the ACS patients’ changes of left ventricular systolic function and diastolic function after PCI. Also, we assess the accuracy of the diagnosis of infarct related artery (IRA) of acute myocardial infarction (AMI) using echocardiography.MethodsSelect 62 patients with ACS who has been passing through a catheter coronary angiography and implanting stents successfully as our case group, which includes 25 cases of unstable angina (UA) patients and 37 cases of acute myocardial infarction patients, all the patients expert color Doppler echocardiography in the 5 days before the operation and 1-3 months after it. Choose 23 cases of healthy volunteers as a control group who also underwent echocardiography.The echocardiographic parameters include:① left ventricular diastolic diameter (LVDd) ② left ventricular systolic diameter (LVDs) ③ left ventricular ejection fraction (LVEF) ④ left ventricular fractional shortening (FS) ⑤ early diastolic mitral inflow blood flow spectrum (E peak), late diastolic flow spectrum (A peak), calculate the E/A value ⑥ peak systolic mitral annular Sa, peak early diastolic Ea, and calculate the E/Ea value, E/Ea×Sa value ⑦ tissue Doppler measurements to calculate the value of Tei index. Compare the indicators of the case group and the control group, analyze the difference. Compare the changes of left ventricular function indicators between preoperation and postoperation in the case group and the AMI group and the UA group; analyze the cases’improvement of cardiac function after PCI.According to the results of coronary angiography, put the AMI group into the left anterior descending artery (LAD) group, the left circumflex artery (LCX) group, the right coronary artery (RCA) group and double-vessel group, according to the abnormalities of the motion site of left ventrical wall in each group, analysis the accuracy of the diagnosis of IRA using two-dimensional echocardiography.Results1. There’s no statistically significant between the case group and the control group with general information (P> 0.05), but the ultrasound indicators were statistically significant (P<0.05), and the control group were better than the case group.2. After PCI, the ACS patients’left ventricular systolic function parameters LVEF, FS have significantly improved (P<0.05), diastolic function parameters E/A increased, E/Ea lower (P<0.05), Tei index, E/EaxSa obvious lower (P<0.05), LVDs shorter (P <0.05).3. After PCI, the UA patients’left ventricular systolic function improved significantly, LVDs shorter (P<0.05), Tei index, E/Ea×Sa lower (P<0.05), diastolic function indicators have improved, but not statistically significant (P> 0.05).4. After PCI, the AMI patients’left ventricular systolic function improved significantly, diastolic function E/Ea increased (P<0.05), Tei index, E/EaxSa lower (P <0.05), LVDs shorter (P<0.05).5. The accuracy of the two-dimensional echocardiography to determine the infarct-related artery were:LAD group 100%, LCX group 80%, RCA group 92.3%, double vessel disease in 100 percent, total accuracy was 94.5%.Conclusion1. ACS can affect the patients’left ventricular function, make the left ventricular internal diameter larger, poor left ventricular wall mobility.2. PCI can significantly improve the left ventricular systolic function in ACS patients recently; the recent improvement of diastolic function in patients with AMI is obvious, but not obvious in patients with UA.3. After PCI, LVDs is significantly reduced in patients with ACS, well LVDd isn’t change significantly.4. The parameters Tei index and E/Ea×Sa reflect the changes of left ventricular function is obvious.5. The two-dimensional echocardiography is accurate in the diagnosis of myocardial. infarction...