Abstract:

Objective To explore the clinical value of different ultrasound methods in assessing the left anterior descending artery (LAD) stenosis. Methods A retrospective analysis was conducted on the ultrasound data of 240 patients diagnosed as the LAD stenosis by coronary angiography (CAG) in our hospital from April 2023 to April 2024, who underwent three different ultrasound evaluation methods, including ventricular wall motion analysis, velocity vector imaging (VVI), and coronary artery flow imaging (CFI). According to the degree of LAD stenosis, patients were divided into the experimental group (stenosis≥50%, n=120) and control group (stenosis<50%, n=120). The wall motion analysis, VVI, and CFI ultrasound characteristics of patients in the two groups were summarized, and the diagnostic efficacy of three different ultrasound methods was analyzed using CAG as the gold standard. Results Wall motion analysis showed that the proportion of regional wall motion abnormalities in the experimental group was significantly higher than that of the control group (P<0.05). VVI showed that the longitudinal peak strain of the anterior interval and anterior wall contraction period in the experimental group was significantly lower than that of the control group (P<0.05). CFI showed that the diastolic peak velocity of LAD in the experimental group was significantly faster than that of the control group (P<0.05). Using the CAG results as the gold standard, the sensitivity of wall motion analysis for diagnosing LAD stenosis≥50% was 0.467, with the specificity of 0.717, accuracy of 0.591, positive predictive value (PPV) of 0.622, and negative predictive value (NPV) of 0.573. VVI in diagnosing LAD stenosis≥50% had a sensitivity of 0.800, specificity of 0.817, accuracy of 0.808, PPV of 0.813, and NPV of 0.803. CFI in diagnosing LAD stenosis≥50% had a sensitivity of 0.850, specificity of 0.783, accuracy of 0.817, PPV of 0.796, and NPV of 0.839. The consistency test results showed that the consistency between wall motion analysis and CAG was average, with a Kappa value of 0.183. VVI, CFI, and CAG showed a high consistency, with Kappa values of 0.617 and 0.633, respectively. The receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of wall motion analysis, VVI, and CFI in diagnosing LAD stenosis was 0.592, 0.808, and 0.817, respectively. Conclusion Abnormal anterior septal and anterior wall motion, decreased anterior septal and anterior wall longitudinal peak strain, and diastolic peak velocity acceleration of LAD are all diagnostic criteria of wall motion analysis, VVI, and CFI for LAD stenosis. However, the diagnostic efficacy of the former one is significantly lower than the latter two. VVI and CFI have a high diagnostic efficacy in diagnosing LAD stenosis and good consistency with CAG, which is worthy of clinical application and promotion.

Key words: coronary stenosis, analysis of ventricular wall motion, velocity vector imaging, coronary artery blood flow imaging