Study On The Relationship Between Left Ventricular Mechanical Changes And Coronary Gensini Score In Patients With Coronary Heart Disease Without RWMA

Objecticve:Automatic functional imaging(AFI)based on two-dimensional speckle tracking imaging(2D-STI)was used to evaluate the regional wall motion in conventional echocardiography The mechanical characteristics of left ventricular myocardium in patients with coronary heart disease(RWMA)and the relationship between them and the degree of coronary artery stenosis were studied.Methods:From June 2018 to February 2019,135 patients with suspected coronary heart disease in our hospital were randomly selected for further examination.All patients received routine two-dimensional echocardiography and stored twodimensional gray-scale dynamic images of four chamber,two chamber and three chamber apical hearts for AFI analysis of left ventricular mechanical properties.24 The final 58 patients with coronary heart disease without obvious RWMA were included in the study,including33 males and 25 females,with an average age of(61.0 ± 10.29)years.77 patients were excluded because of the following exclusion criteria: RWMA seen on two-dimensional echocardiography,acute or old myocardial infarction,after percutaneous coronary intervention,serious arrhythmia,history of coronary artery bypass or valvular heart disease,serious systemic disease,kidney and liver disease,pericardial disease,congenital heart disease,QRS duration ≥ 120 ms,cardiac function < 55% And poor image quality.33 healthy subjects were randomly selected as the control group,including 19 males and 14 females,with an average age of 62.06± 5.84.Left ventricular end diastolic diameter(LVEDD)and left atrial diameter(LAD)were measured by conventional ultrasound,,stroke volume(SV)and left ventricular ejection fraction(LVEF)were measured by Teich method.The global long-axis peak strain(GLPs),peak strain dispersion(PSD)and longitudinal strain difference(LSD) were measured by AFI.Ratio of longitudinal strain difference to global longitudinal strain(LSR).Patients in coronary heart disease group were divided into three groups according to the three quantile method of Gensini score: Gensini score < 13 was divided into mild disease group(19 cases),13 ≤Gensini score < 43 was divided into moderate disease group(20 cases),Gensini score ≥ 43 was divided into severe disease group(19 cases).To compare the changes of two dimensional echocardiography and AFI parameters between patients with coronary heart disease and normal control group and three groups of patients with coronary heart disease.Results:Compared with the control group,there was no significant difference in SV(%: 67.69± 12.05 vs 67.64 ± 8.91)and LVEF(%: 64.59 ± 2.29 vs 65.27 ± 2.98)measured by two-dimensional echocardiography,but there was no significant difference(P > 0.05).There was no significant difference in SV and LVEF between the three groups(P>0.05).Compared with the normal control group,there was no significant difference(P< 0.01)in AFI parameter values of LSD and PSD,and the absolute value of GLPs(%:-18.2 ± 2.64 vs-21.8 ± 1.23)decreased,the difference was statistically significant(P< 0.01),while LSR(%: 0.82 ± 0.27 vs 0.62 ± 0.13)increased,the difference was statistically significant(P< 0.01).In the coronary heart disease group,compared with the mild group,the absolute value of GLPs in the moderate group(%:-18.57 ± 1.84 vs-20.52 ± 1.48)and the severe group(%:-15.48 ± 1.64 vs-20.52 ±1.48)decreased,and the difference was statistically significant(P< 0.01);compared with the moderate group,the absolute value of GLPs in the severe coronary heart disease group(%:-15.48 ± 1.64)The absolute value of vs-18.57 ± 1.84)was further reduced,the difference was statistically significant(P< 0.01),but there was no significant difference in LSD,LSR and PSD among the three groups(P>0.05).Pearson correlation analysis showed that GLPs,LSD,PSD were positively correlated with Gensini score(r = 0.871,0.595,0.271,P< 0.05),while LSR was not significantly correlated with Gensini score(P> 0.05).The sensitivity,specificity and area under curve(AUC)of GLPs with absolute value less than 17.850 were 94.7%,84.6% and0.953 respectively.Conclusion:For patients without obvious RWMA found by conventional two-dimensional ultrasound,the left ventricular myocardial strain parameters obtained by AFI technology based on 2D-STI can be used as the basis to evaluate the degree of coronary artery stenosis in patients with coronary heart disease,which reflects the characteristics of myocardial contraction function and strain,which is helpful for clinical doctors to noninvasively evaluate the degree of coronary artery stenosis and select the appropriate diagnosis and treatment scheme.