Two-dimensional Combined with Three-dimensional Speckle Tracking Imaging Predicted Myocardial Viability in Patients Undergoing Coronary Artery Bypass Grafting

ZHANG Yaping; WANG Hua; XING Yanyan; MAI Peipei; ZHANG Shefang; PAN Danyang

doi:10.12102/j.issn.1672-1349.2025.20.020

Abstract：Objective: To explore the value of two-dimensional and three-dimensional speckle tracking technology (STI) in assessing myocardial viability in patients undergoing coronary artery bypass grafting (CABG), and to provide a non-invasive method for clinical evaluation of myocardial viability. Methods: A prospective study was conducted on 36 patients with coronary heart disease and left ventricular dysfunction who were scheduled for CABG. Dynamic two-dimensional and three-dimensional echocardiographic images were collected before and after surgery. The gold standard for defining non-viable myocardium was the segment with absent or paradoxical wall motion that showed no improvement post-surgery. Preoperative two-dimensional and three-dimensional strain parameters were compared between viable and non-viable myocardial segments. Receiver operating characteristic (ROC) curves were drawn for strain parameters and combined parameters to calculate the area under the curve (AUC), cut-off values, sensitivity, specificity, and accuracy. Results: A total of 29 patients were finally included, with 321 segments defined as viable myocardium and 39 segments as non-viable myocardium. The absolute values of two-dimensional and three-dimensional strain parameters were significantly lower in the non-viable myocardium group compared to the viable myocardium group. The diagnostic cut-off values for preoperative subepicardial longitudinal strain (LSepi) and three-dimensional area strain (3D-AS) in distinguishing viable from non-viable myocardium were -5.5% and -10.5%, respectively, with corresponding diagnostic sensitivities, specificities, and accuracies of 87.2%, 62.9%, 68.3% and 89.7%, 75.1%, 76.4%. The AUCs were 0.794 and 0.876, respectively, with statistically significant differences (P < 0.05). The combined diagnostic performance of LSepi and 3D-AS was the best, with an AUC of 0.904, and the sensitivity, specificity, and accuracy were 84.6%, 81.0%, and 91.4%, respectively. Conclusion: The combination of LSepi and 3D-AS has high value in assessing myocardial viability in patients with coronary heart disease and left ventricular dysfunction, and can provide more reliable information for clinical treatment planning and prognosis evaluation.