Evaluation of left ventricular endocardial echo enhancement and its relationship with coronary artery lesions by two-dimensional speckle tracking imaging
Objective To measure the strain parameters of the subendocardial myocardium in the left ventricle in patients with endocardial echo enhancement by two-dimensional speckle tracking imaging(2D-STI),and to explore the relationship between the left ventricular endocardial echo enhancement and myocardial ischemia and coronary artery disease.Methods A total of 80 patients with left ventricular endocardial echo enhancement who underwent echocardiography in our hospital were selected.According to the standard of Gensini score,the participants were devided into coronary artery without lesion group(28 cases,Gensini score=0),mild lesion group(26 cases,0<Gensini score<25),and moderate to severe lesion group(26 cases,Gensini score≥25).The incidence of left ventricular endocardial echo enhancement in each group was recorded,as well as the correspondence of the segments supplied by the diseased coronary arteries.The thickness and area of left ventricular endocardial echo enhancement were measured.The global peak longitudinal strain and circumferential strain(GLSendo,GCSendo)of left ventricular subendocardial myocardium,apical 4-chamber peak longitudinal strain(AP4LSendo),apical 3-chamber peak longitudinal strain(AP3LSendo),apical 2-chamber peak longitudinal strain(AP2LSendo),and endocardial echo enhancement site peak longitudinal strain and circumferential strain(LSendo-ee,CSendo-ee),short-axis basal segment peak circumferential strain(SAXBCSendo),short-axis mid-segment peak circumferential strain(SAXMCSendo),and short-axis apical segment peak circumferential strain(SAXACSendo)were obtained by 2D-STI.The differences of the above parameters were compared among the groups.The correlation between left ventricle endocardial echo enhancement thickness and area,left ventriclar subendocardial myocardial strain parameters and Gensini score were analyzed.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficiency of each parameter in the diagnosis of moderate and severe coronary artery disease.Results There were no statistically significant differences in incidence of left ventricular endocardial echo enhancement among the groups.The correspondence rate between myocardial segments with enhanced left ventricular endocardial echo and the myocardial segments supplied by the diseased coronary artery was relatively high in both the mild lesion group and the moderate to severe lesion group(75.0%and 72.6%),respectively.Compared with the coronary artery without lesion group,GLSendo,GCSendo,AP4LSendo,LSendo-ee,CSendo-ee,SAXACSendo and the thickness of left ventriclar endocardial echo enhancement were increased in the mild lesion group,with statistically significant differences(all P<0.05).Compared with the coronary artery without lesion group and mild lesion group,the GLSendo,GCSendo,AP4LSendo,AP3LSendo,AP2LSendo,LSendo-ee,CSendo-ee,SAXBCSendo,SAXMCSendo were increased in the moderate to severe lesion group,with statistically significant differences(all P<0.05).Correlation analysis showed that the GLSendo,GCSendo,AP4LSendo,AP3LSendo,AP2LSendo,SAXBCSendo,SAXMCSendo,the thickness of endocardial echo enhancement were positively correlated Gensini score in patients with coronary artery lesions(all P<0.05).ROC curve analysis showed that the area under the curve of GLSendo,GCSendo,AP4LSendo,AP3LSendo,AP2LSendo,SAXBCSendo,SAXMCSendo in the diagnosis of moderate to severe coronary artery were 0.788,0.685,0.709,0.813,0.710,0.713,0.780(all P<0.05),respctively.Conclusion 2D-STI can be used to assess subendocardial myocardial strain parameters in patients with left ventricular endocardial echo enhancement,providing an initial assessment of myocardial ischemia and the degree of coronary artery disease,and it has certain clinical value for predicting the likely coronary artery based on the location of endocardial echo enhancement.
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