| Objective: Coronary slow flow(CSF)refers to the phenomenon of delayed distal vessel perfusion without significant coronary artery stenosis detected by coronary angiography(CAG).CSF seriously affects the quality of life of patients,which should be paid attention to in clinic.Tissue motion annular displacement(TMAD)is a new technique developed in recent years.The aim of this study was to use TMAD parameters to detect left ventricular systolic function in patients with CSF,and to compare with left ventricular ejection fraction(LVEF)and left ventricular global longitudinal strain(LVGLS)to further clarify the clinical value of TMAD parameters.At present,there is no normal reference value of TMAD parameters,which is limited in clinical application.Therefore,the establishment of reference values of TMAD parameters is helpful for clinical diagnosis.we aim to explore the reference value of TMAD parameters in adults and discuss its influencing factors.Methods:1.The clinical value of TMAD in evaluating left ventricular systolic function in patients with CSF: A total of 64 CSF patients(CSF group)and 50 control patients(CON group)were selected in our hospital.The general clinical data and coronary angiography data of the patients were collected.Philips IE33 color Doppler ultrasound diagnostic instrument was used to obtain standard two-dimensional ultrasound images and off-line analysis.Conventional ultrasonic parameters : left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),interventricular septal thickness(IVS),left ventricular posterior wall thickness(LVPW),left atrium dimension(LA),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),LVEF,peak velocity of mitral valve in early diastole(ME),peak velocity of mitral valve in late diastole(MA),peak velocity of tricuspid valve in early diastole(TE),peak velocity of tricuspid valve in late diastole(TA)and so on.Tissue doppler imaging(TDI)was used to measure the septal mitral annulus velocity in early diastole(e1),lateral mitral annulus velocity in early diastole(e2);two-dimensional speckle tracking imaging was used to measure the left ventricular global longitudinal strain(LVGLS),tissue motion annular displacement(TMAD): septal tissue motion annular displacement(TMAD1),lateral tissue motion annular displacement(TMAD2),midpoint tissue motion annular displacement(TMADmid),percentage value of the midpoint displacement in relation to the total length of the left ventricle(TMADmid%).Compare the parameters between the two groups.Correlation analysis: The correlation between TMAD parameters and LVEF,LVGLS and angiography results was analyzed.Multivariate logistic regression analysis was used to analyze the independent predictors of CSF.ROC curve was used to evaluate the predictive value of each parameter for CSF.Feasibility analysis of parameters: the success rate of image acquisition of LVEF,LVGLS and TMAD parameters was calculated,and the image analysis time was recorded was recorded.Intraobserver and interobserver reproducibility were analyzed in 20 patients with excellent image quality and 20 patients with poor image quality.2.Reference values of TMAD and the influencing factors: 240 healthy persons were selectedfrom our hospital physical examination center(age: ≥20 years).They were divided into 6 groups by age: 20-29 years,30-39 years,40-49 years,50-59 years,60-69 years and ≥70 years.There were 20 males and 20 females in each group.The general clinical data of the subjects were collected,and the conventional ultrasound parameters and TMAD parameters were measured and collected,as in Part I.The differences of parameters between males and females were analyzed.The percentile method was used to propose the reference values of TMAD parameters according to different genders.Multiple linear regression analysis was used to analyze the influencing factors.Results:1.The clinical value of TMAD in evaluating left ventricular systolic function in patients with CSF.(1)Comparison of general clinical data and angiographic data: 64 CSF patients and50 con patients were finally included in the study.There was no significant difference in general clinical data between CSF group and CON group.c TFC-LAD,TFC-LCX,TFC-RCA and mean TFC(m TFC)values of CSF patients were significantly higher than those of CON group(P < 0.05).The involvement rates of LAD,LCX and RCA in CSF patients were 91%,72% and 64%,respectively.The proportion of patients with 1,2 and 3 coronary artery involvement was 17%,39% and 44%,respectively.(2)Changes in conventional ultrasound parameters and LVGLS in patients with CSF:LVPW,PV,ME,M-E/A,E/e’ and LVGLS in CSF group were lower than those in CON group(P < 0.05),while LVEF had no significant difference.(3)The changes of TMAD parameters in CSF patients: TMAD parameters were lower than those in CON group(P < 0.05).(4)Correlation analysis of TMAD with LVEF and LVGLS: All TMAD parameters were negatively correlated with LVGLS(P < 0.001),and TMAD2,TMADmid and TMADmid% were positively correlated with LVEF(P < 0.05),among which TMADmid% had the highest correlation with LVEF and LVGLS(r= 0.34,P < 0.001;r=-0.66,P < 0.001).(5)Correlation analysis between TMAD and angiographic results: all parameters of TMAD were negatively correlated with the number of involved coronary arteries and m TFC,among which TMADmid% had the highest correlation with the number of involved coronary arteries and m TFC(r=-0.39,P < 0.001;r=-0.32,P < 0.001).(6)The predictive value of TMAD parameters for CSF: multivariate logistic regression analysis showed that M-E/A,TMAD2 and TMADmid% were independent predictors of CSF(P < 0.05).ROC curve analysis showed that LVGLS,TMAD parameters and the combination of TMAD2,TMADmid% and M-E/A had significant significance in predicting the occurrence of CSF in the population(P < 0.05).The combination of TMADmid% and M-E/A had the largest AUC for identifying CSF(AUC: 0.76;95%CI: 0.67-0.83;P < 0.001),Among the single parameters,the AUC of each TMAD parameter in identifying CSF(AUC: 0.63-0.73)was greater than that of LVGLS(AUC: 0.62).TMADmid% had the largest AUC(AUC: 0.73;95%CI:0.64-0.81;P< 0.001)with an intercept point of 14.8%(sensitivity: 81.3%;specificity:60.0%).(7)Parameter feasibility analysis: the success rate of image acquisition of TMAD parameters was higher than that of LVGLS and LVEF(97.0% vs.89.4%,P<0.05;97.0% vs.89.4%,P < 0.05).The image analysis time of TMAD parameters was shorter than that of LVGLS and LVEF(7.67s±1.05 s vs.92.67s±7.36 s,P < 0.001;7.67 ±1.05 s vs.44.77 ±5.63 s,P < 0.001).In patients with excellent image quality,LVEF,LVGLS and TMAD parameters have good intra-observer and inter-observer reproducibility.Compared with LVEF and LVGLS,TMAD parameters had higher ICC,TMADmid% had the highest ICC and the lowest Co V.In patients with poor image quality,TMAD parameters still have excellent intra-observer and inter-observer reproducibility,while the intra-observer reproducibility of LVEF and LVGLS is good,and the inter-observer reproducibility of LVEF and LVGLS is fair.2.Reference values of TMAD and the influencing factors.(1)Comparison of general clinical data : Height,weight,BSA,BMI,SBP,DBP,Hb,RBC,WBC,ALT,Cr,Urea were higher in males than in females,while HDL-C was lower.In addition,the proportion of men with a history of smoking and drinking was higher than that of women(P < 0.05).(2)Comparison of ultrasound parameters: LVEDD,LVESD,LVEDV and LVESV of males were higher than those of females,while ME,MA,LVEF and TMADmid% of males were lower than those of females(P < 0.05).There was no significant difference in other parameters.(3)The reference ranges of TMAD parameters for different genders:Reference range of TMAD parameters in the population(TMAD1: 6.2-15.9mm,TMAD2: 5.9-19.6mm,TMADmid: 7.1-17.4mm,TMADmid%: 8.5-20.8%).Reference range of TMAD parameters in males(TMAD1: 5.3-17.0mm,TMAD2:4.9-19.6mm,TMADmid: 7.1-17.4mm,TMADmid%: 7.9-19.9%).Reference range of TMAD parameters in females(TMAD1: 6.2-15.8mm,TMAD2:5.9-19.6mm,TMADmid: 6.9-17.8mm,TMADmid%: 8.7-21.6%).(4)The influencing factors of TMAD parameters: TMAD1 was negatively correlated with age,BMI,SBP,GLU,and TG.TMAD2 was negatively correlated with age,SBP,DBP,GLU and LDL-C.TMADmid was negatively correlated with age,BMI,SBP,DBP,GLU and LDL-C.TMADmid% was negatively correlated with age,BSA,BMI,SBP,DBP,GLU and LDL-C,and positively correlated with HDL-C(P < 0.05).Parameters with P < 0.05 in the univariate linear regression analysis were included in the multivariate linear regression analysis.The results showed that age,BMI and DBP were the influencing factors of TMAD1,age was the influencing factors of TMAD2 and TMADmid,and age,BSA,SBP and HDL-C were the influencing factors of TMADmid%.Conclusions:1.TMAD parameters are decreased in patients with CSF,and TMAD parameters are correlated with the number of involved vessels and m TFC,which can reflect the severity of CSF.2.TMAD parameters,especially TMADmid%,can be used as reliable indicators to evaluate left ventricular systolic function in patients with CSF.3.Compared with LVEF and LVGLS,the acquisition of TMAD parameters is more efficient,TMAD parameters have better reproducibility and do not depend on image quality.4.The reference values of TMAD parameters are proposed.5.Age,BSA and blood pressure are the influencing factors of TMAD parameters. |
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