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Assessment of Global and Regional Left Ventricular Function After Surgical Revascularization in Patients With Coronary Artery Disease by Real-time Triplane Echocardiography

Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China (M.R., J.-W.T., X.-P.L., Y.W., Z.-Z.W.); and Echocardiagraphic Department, Daqing Oil Field General Hospital, Daqing, China (H.-M.W.).

Address correspondence to Jia-Wei Tian, MD, Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Rd Nangang District, 150086 Harbin, China. E-mail: jwtian2004{at}yahoo.com.cn

Objective. The purpose of this study was to evaluate the capability of real-time triplane echocardiography (RT3PE) for monitoring global and regional systolic function of the left ventricle (LV) after surgical revascularization and for evaluating the effect of surgery and predicting restenosis. Methods. Forty-nine patients underwent RT3PE before and at 10 days and 1, 3, and 6 months after coronary artery bypass grafting (CABG). The global systolic function of the LV was assessed with the parameters of end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), and stroke volume (SV). The regional myocardial deformation was detected by triplane strain rate imaging. Recovery of myocardial function after surgery and the correlation between global and regional function were investigated. Results. In 41 of the 49 patients, the EDV and ESV decreased, and the EF and SV increased gradually and showed statistical significance at 3 and 6 months after surgery (P < .05; P < .01). The systolic strain rate (SR_sys) and systolic strain (S_sys) increased, and the postsystolic strain index (PSI) decreased progressively after CABG, with significant changes in almost all studied segments at 6 months (P < .05; P < .01). In addition, recovery of the SR_sys, S_sys, and PSI at each follow-up stage after surgery correlated well with EF improvement, with a positive correlation between the SR_sys, S_sys, and EF and a negative correlation between the PSI and EF. Restenosis was suspected in the other 8 patients. The sensitivity, specificity, and accuracy of RT3PE to predict restenosis were 75.00%, 89.47%, and 85.19%, respectively. Conclusions. Real-time triplane echocardiography can be used to quantitatively assess global and regional myocardial function. It may represent a new, powerful method to monitor improvement of myocardial function after CABG and to predict restenosis.

Key Words: coronary artery bypass grafting • left ventricular function • real-time triplane echocardiography • strain rate imaging

Abbreviations: bAS, basal anterior septum • bAW, basal anterior wall • CABG, coronary artery bypass grafting • CAD, coronary artery disease • CT, computed tomographic • DSE, dobutamine stress echocardiography • ECG, electrocardiography • EDV, end-diastolic volume • EF, ejection fraction • ESV, end-systolic volume • LAD, left anterior descending • LV, left ventricle • LVEF, left ventricular ejection fraction • mAS, mid anterior septum • mAW, mid anterior wall, mIS, mid inferior septum • PSI, postsystolic strain index • PSS, postsystolic shortening • RT3PE, real-time triplane echocardiography • 64-DCT, 64–detector row computed tomographic • S_max, maximal strain • SRI, strain rate imaging • SR_sys, systolic strain rate • S_sys, systolic strain • SV, stroke volume • TDI, tissue Doppler imaging • 2DE, 2-dimensional echocardiography