Evaluation of left ventricular function in patients with different degrees of stenosis in the left anterior descending branch by myocardial work combined with stress echocardiography
10.3760/cma.j.cn131148-20240820-00450
- VernacularTitle:心肌做功联合负荷超声心动图评估左前降支不同程度狭窄患者左心室功能
- Author:
Dan YU
1
;
Cuixing LIANG
;
Tianle YU
;
Jiacheng LI
;
Yumeng WU
;
Li XUE
Author Information
1. 哈尔滨医科大学附属第四医院心血管超声科，哈尔滨 150001
- Publication Type:Journal Article
- Keywords:
Echocardiography，stress;
Myocardial work;
Coronary artery stenosis;
Coronary flow reserve
- From:
Chinese Journal of Ultrasonography
2025;34(2):129-138
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate left ventricular function and myocardial ischemia in patients with different degrees of left anterior descending（LAD）coronary artery stenosis by using post-stress regional myocardial work（MW）and coronary flow reserve（CFR），and to analyze the diagnostic efficacy of each parameter for different degrees of stenosis in the LAD.Methods:A retrospective analysis was conducted on 76 patients with suspected coronary artery disease who underwent coronary angiography and attended the Fourth Affliiated Hospital of Harbin Medical University from January 2023 to June 2024. According to the degree of LAD stenosis，30 cases were categorized into the mild stenosis group（stenosis < 50%），25 cases in the moderate stenosis group（50%≤stenosis < 70%），and 21 cases in the severe stenosis group（70% ≤ stenosis ≤ 90%）. Transthoracic Doppler echocardiography was applied to obtain CFR LAD. Longitudinal strain in the left anterior descending region（LS LAD），peak strain dispersion（PSD），left anterior descending region work index（WI LAD）and left anterior descending region work efficiency（WE LAD）were obtained at rest and under stress，respectively. The LAD regional MW indexes were compared between the groups in two pairs. The correlation between CFR LAD and the degree of LAD stenosis was analyzed. ROC curves were plotted to compare the diagnostic efficacy of LAD regional MW parameters and CFR LAD for moderate and severe LAD stenosis. Results:①At rest：compared with the mild stenosis group，the absolute value of LS LAD，WI LAD，and WE LAD were reduced in the severe stenosis group，and the differences were statistically significant（all P < 0.05）. Compared with the moderate stenosis group，WE LAD was reduced in the severe stenosis group，and the difference was statistically significant（ P < 0.05）. Differences in two-by-two comparisons between groups in the resting state for the remaining parameters were not statistically significant（all P > 0.05）. Under stress：compared with the mild stenosis group，the absolute values of LS LAD，WI LAD，and WE LAD were reduced in the moderate and severe stenosis groups，and the PSD was increased in the severe stenosis group，and the differences were statistically significant（all P < 0.05）. Compared with the moderate stenosis group，the absolute values of LS LAD，WI LAD，and WE LAD were reduced in the severe stenosis group，and the differences were statistically significant（all P < 0.05）. Differences between two-by-two comparisons between groups in the remaining parameters at loading state were not statistically significant（all P > 0.05）. ②CFR LAD was negatively correlated with the degree of LAD stenosis（ r = -0.809， P < 0.05）. ③The ROC curves showed that the peak WE LAD of the regional MW parameters predicated the largest area under the ROC curve（AUC）for moderate and severe stenosis in LAD，0.803 and 0.897，respectively，with cutoff values of 92.5% and 91.5%. The cutoffs of CFR LAD ≤ 2.5 and CFR LAD ≤ 2.0 predicted the greatest AUC for moderate and severe stenosis in LAD at 0.743 and 0.901，respectively. Peak WE LAD combined with CFR LAD predicted the greatest AUC for moderate and severe stenosis in LAD at 0.826 and 0.967，respectively. Conclusions:Regional MW parameters and CFR LAD can sensitively detect left ventricular hypo-function in patients with different degrees of stenosis in LAD. Peak WE LAD and CFR LAD are reliable predictors of moderate and severe stenosis in LAD. A combination of the two techniques can significantly improve diagnostic efficacy.
