Clinical value of adenosine stress echocardiography combined with left ventricular pressure-strain loop in predicting the degree of in-stent restenosis after percutaneous coronary intervention
Objective To measure the myocardial work parameters of myocardial segments with in-stent restenosis after percutaneous coronary intervention(PCI)by adenosine stress echocardiography(ASE)combined with pressure-strain loop(LVPSL),and to explore its clinical application value for predicting the degree of coronary artery restenosis.Methods Forty-one patients with in-stent restenosis after PCI diagnosed by coronary angiography were selected from our hospital,excluding the 12 segments with unsatisfactory images before and after adenosine loading,a total of 726 myocardial segments were obtained,of which 300 segments with a stenosis degree of<50%(no significant stenosis group),175 segments with a stenosis degree of 50%～75%(moderate stenosis group)and 251 segments with a stenosis degree of>75%(severe stenosis group),and the differences of longitudinal strain(LS),constructive myocardial work(CMW),wasted work(WW),myocardial work index(MWI)and myocardial work efficiency(MWE)of myocardial segments among groups were compared.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of each parameters at basal and loading states for evaluating severe coronary artery stenosis after PCI.Results Compared with no significant stenosis group,LS,MWI,MWE and CMW decreased and WW increased at basal and loading states in moderate stenosis group,and LS,MWI,MWE and CMW decreased at basal and loading states in severe stenosis group,and WW increased at loading state,and the differences were statistically significant(all P<0.01).Compared with the moderate stenosis group,LS,MWI,MWE,CMW decreased and WW increased at loading state in severe stenosis group,and the differences were statistically significant(all P<0.01).Compared with the basal state,LS,MWI,MWE,CMW increased and WW decreased at loading state in no significant stenosis group and moderate stenosis group,and the differences were statistically significant(all P<0.05).In the Severe stenosis group,LS,MWI,MWE,CMW decreased and WW increased at loading state,and the differences were statistically significant(all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of MWI,MWE and CMW at loading state for predicting severe coronary artery stenosis after PCI were 0.829,0.766 and 0.841,respectively,all of which were higher than those at basal state,and the AUC of CMW at loading state for predicting severe coronary artery stenosis after PCI was higher than that of MWE and WW at loading state,and the differences were statistically significant(all P<0.001).The difference in AUC was not statistically significant between CMW and MWI at loading state for predicting severe coronary stenosis after PCI.Conclusion ASE combined with LVPSL can effectively evaluate the myocardial work of restenosis myocardial segments after PCI,and it has certain clinical application value in predicting the degree of coronary artery stenosis.
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