Evaluation of left ventricular diastolic function by strain rate parameters in patients with coronary artery disease without regional wall motion abnormalities / 中华超声影像学杂志

ABSTRACT

Objective:To investigate the value of early diastolic strain rate (e′SR) and peak value of early diastolic velocity (E) to e′SR (E/e′SR) in predicting the severity of coronary lesions in patients with coronary artery disease (CAD) without regional wall motion abnormalities (RWMA) and with preserved left ventricular ejection fraction (LVEF).Methods:A selection of 70 patients with CAD without RWMA and with preserved LVEF (>50%) admitted to Zhengzhou University People′s Hospital from October 2020 to March 2021 were collected and divided into two groups according to the Gensini score method: low group with a score<34 and high group with a score≥34. Another 30 healthy volunteers with matching gender and age at the same period were selected as the control group. Cardiac structural parameters left atrium diameter (LAD), left ventricular end diastolic diameter (LVEDd), left ventricular end systolic diameter (LVEDs), interventricular septum diastolic diameter (IVST), left atrial volume (LAV), E, peak value of late diastolic velocity (A) of mitral inflow, peak value of early diatolic tissue Doppler velocity of septal and lateral walls of mitral annulus and LVEF were routinely measured. Left atrial volume index (LAVI), mean of peak value of early diatolic tissue Doppler velocity of septal and lateral walls of mitral annulus (e′), E/e′were calculated. Speckle tracking imaging (STI) technique was used to collect systolic left ventricular global longitudinal strain (GLS) and e′SR, E/e′SR was calculated. The differences in each parameter among the three groups were compared. The ROC curve was used to obtain the best cut-off values of e′SR and E/e′SR for predicting the severity of coronary lesions in CAD patients, respectively, and the corresponding sensitivity and specificity were obtained, respectively.Results:Compared with the control group, LAV and LAVI were increased in the high group (all P<0.05). Compared with the control and the low group, e′ was decreased and E/e′ was increased in the high group (all P<0.05). Compared with the control group, e′SR and GLS were decreased and E/e′SR were increased in the high and low groups (all P<0.05). Compared with the low group, e′SR and GLS were decreased and E/e′SR was increased in the high group (all P<0.05). ROC curve analysis showed that the maximum area of E/e′SR under the curve was 0.717. When the Youden index was maximum, its best cut-off value was 0.75 m, and corresponding sensitivity and specificity were 60.0% and 85.7%, respectively. The maximum area under the e′SR curve was 0.785. When the Youden index was maximum, its best cut-off value was 1.12 s -1, and the corresponding sensitivity and specificity were 85.7% and 68.6%, respectively. Conclusions:For CAD patients without significant RWMA and with preserved LVEF, left ventricular diastolic and systolic function may be impaired to varying degrees, manifesting as decreased e′SR, increased E/e′SR, decreased GLS. The parameters of diastolic strain rate are a reliable basis for early detection of impaired diastolic function in CAD patients, and have certain clinical significance for predicting the severity of coronary lesions.