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| 題名: | CLINICAL APPLICATION OF TISSUE TRACKING TECHNOLOGY IN CARDIOVASCULAR ULTRASOUND |
| 作者: | CHAICHUUM, SRISAKUL |
| 貢獻者: | 生醫材料暨組織工程研究所博士班
TSENG, CHING-LI
CHIANG, SHUO-JU
CHEN, HSIANG-HO |
| 關鍵詞: | tissue tracking technique;myocardial strain;coronary artery disease;stenosis rate;vessel myocardial strain;vessel myocardial strain rate;COVID-19 vaccination;cardiac-related adverse event |
| 日期: | 2023-01-17 |
| 上傳時間: | 2023-12-07 09:39:26 (UTC+8) |
| 摘要: | Tissue tracking technology is an innovatory development of the Doppler technique that has been used for study of cardiac function in clinical practice, which reveals the major cardiac changes in individuals with cardiac complications. Two-dimensional speckle tracking echocardiography (2D-STE) has been regarded as a diagnostic tool for the heart failure and coronary artery disease (CAD). This imaging modality is approachable, cost-effective, non-radiative, non-invasive with high specificity and sensitivity for functional assessment of left ventricle (LV) and particularly early detection of subclinical myocardial dysfunction in disease process. Nevertheless, the hypothesis that strain and strain rate (SR) of vessel supplied myocardium can predict the severity degree of coronary artery stenosis in patients with CAD has yet been proven. Therefore, this study aimed to investigate association between cardiac mechanical variables derived by tissue tracking technology and the conditions of coronary artery stenosis diagnosed by coronary angiography in patients with clinically diagnosed CAD. Moreover, the application of speckle tracking technique was expended to detect subtle change of LV myocardium in patients who developed cardiac adverse effects (AEs) after coronavirus disease 2019 (COVID-19) vaccination
The cross-sectional studies were conducted. For the study of CAD, all suspected CAD patients were recruited as selection criteria and underwent echocardiography and coronary angiography. Clinical characteristics including serological test such as blood glucose, lipid profile, kidney function were collected. Risk factors of cardiovascular disease such as smoking status, family history, diabetes, hypertension, and the medication used were recorded. To evaluate the anatomical and functional abnormality of left ventricle, comprehensive transthoracic echocardiography (TTE) was examined within 2-3 weeks before coronary angiography. Linear and volumetric measurement of the LV, mitral valve inflow and myocardial velocities were quantified. The gray-scale images of cardiac chambers in apical 4-, 3-, and 2-chamber windows from conventional echocardiography were recorded for further analysis of tissue speckle tracking. 2D-STE using EchoPAC (GE healthcare) software was analyzed offline to assess global myocardial strain. The average longitudinal strain and SR of the regional myocardium supplied by each coronary artery were formulated to achieve vessel myocardial strain (VMS) and strain rate (VMSR). The calculation was constructed and modified based on the coronary artery distribution along left ventricle. Coronary angiography was performed to diagnose the actual stenosis condition of coronary arteries including left anterior descending artery (LAD), right coronary artery (RCA) and circumflex coronary artery (LCX). In terms of data analysis, variables from patient characteristics, echocardiography and global strain and SR, were divided into two groups according to significant and insignificant CAD, with ?70% and <70% diameter stenosis of coronary artery, respectively. The VMS and VMSR were categorized into four severity levels, cases with ?25% stenosis is mild (group I); cases with 26-49% stenosis is moderate (group II); cases with 50-74% stenosis is severe (group III) and cases with ?75% is very severe (group IV). The comparisons among groups were performed statistically. For the study of cardiac AEs following COVID-19 vaccine, individuals who had vaccinated with COVID-19 at least one dose were recruited as criteria. Blood tests and TTE were examined within six weeks after vaccination. Speckle tracking technique was applied to evaluate the subtle change of the LV. The information of patient characteristics, serological test, TTE, and 2D-STE from patients who had cardiac AEs and normal, was compared.
The results from CAD group study demonstrated that VMS and VMSR indices showed significant differences among groups of severity degrees of coronary artery stenosis (p = 0.016, and p < 0.001, respectively). The average VMS and VMSR in very severe stenosis group (?75%; n=29), 13.9 ± 4.3, and 0.9 ± 0.3, respectively, were smaller than those of mild stenosis group (?25%; n=88), 16.9 ± 4.9, p = 0.023, and 1.2 ± 0.3, p = 0.001, respectively. The average VMSR in moderate stenosis group (26%-49%; n=37), 1.0 ± 0.2, was smaller than that in mild stenosis group (p = 0.021). The lower VMS and VMSR, the more likelihood of severe coronary stenosis is. The VMS and VMSR lower than 13.9 ± 4.3 and 0.9 ± 0.3, respectively implied the severe coronary stenosis whereas VMS and VMSR higher than 16.9 ± 4.9 and 1.2 ± 0.3, respectively implied no or mild coronary artery stenosis.
Cardiac AEs following COVID-19 vaccination study showed that there were 59 patients (89%) developing chest tightness, 23 patients (35%) having palpitations, 21 patients (32%) having dyspnea, and 6 patients (9%) with chest pain. Blood tests were compared between cardiac AEs and control groups. All subjects had normal creatine kinase myocardial band (10.4 U/L; IQR, 2.3-14.7), creatine phosphokinase (93.0 U/L; IQR, 66.5-137.5), N-terminal pro b-type natriuretic peptide (44.5 pg/mL; IQR, 20.2-79.5), Troponin T (6.0 ng/L; IQR, 4.0-8.5), D-dimer (0.3 mg/L; IQR, 0.1-0.4), and platelet count (222.0 x 10?/????L; IQR, 199.2-275.5). Conventional cardiac ultrasound showed normal left ventricular ejection fraction in the symptomatic group (71.41% ± 7.12%) and the control groups (72.18% ± 5.11%) (p=0.492). Nevertheless, the cardiac AEs group had greater ratio of mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (e’) (9.32 ± 3.56) than those in the normal group (7.74 ± 2.34) (p = 0.005), corresponding with e’ (8.64 ± 3.96 vs 10.25 ± 3.58, respectively; p = 0.023). 2D-STE presented that global longitudinal strain (GLS) and global circumferential strain (GCS) in the symptomatic group (17.86% ± 3.22% and 18.37% ± 5.22%) was reduced compared to the normal group (19.54% ± 2.18% and 20.73% ± 4.09%) (p = 0.001 and p = 0.028).
The clinical applications of 2D-STE in cardiac ultrasound were proven that these techniques were able to evaluate stenosis condition of coronary artery using formulated VMS and VMSR, and early assess subclinical change of LV myocardium after COVID-19 vaccine-related cardiac adverse outcomes using GLS and GCS. |
| 描述: | 博士
指導教授:TSENG, CHING-LI
共同指導教授:CHIANG, SHUO-JU
共同指導教授:CHEN, HSIANG-HO
委員:WANG, RU-ER
委員:HSU, CHUAN-CHIH
委員:LIN, YEN-CHUNG
委員:CHANG, SHIH-LIN
委員:TSENG, CHING-LI
委員:CHIANG, SHUO-JU |
| 資料類型: | thesis |
| 顯示於類別: | [生醫材料暨組織工程研究所] 博碩士論文
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