Cwajg J M, Cwajg E, Nagueh S F, He Z X, Qureshi U, Olmos L I, Quinones M A, Verani M S, Winters W L, Zoghbi W A
Section of Cardiology, Baylor College of Medicine, Houston, Texas 77030, USA.
J Am Coll Cardiol. 2000 Apr;35(5):1152-61. doi: 10.1016/s0735-1097(00)00525-8.
The study assessed whether end-diastolic wall thickness (EDWT), measured with echocardiography, is an important marker of myocardial viability in patients with suspected myocardial hibernation, and it compared this index to currently established diagnostic modalities of dobutamine stress echocardiography (DSE) and rest-redistribution thallium-201 (T1-201) scintigraphy.
Because myocardial necrosis is associated with myocardial thinning, preserved EDWT may provide a simple index of myocardial viability that is readily available from the resting echocardiogram.
Accordingly, 45 patients with stable coronary artery disease and ventricular dysfunction underwent rest 2D echocardiograms, DSE and rest-redistribution T1-201 tomography before revascularization and a repeat resting echocardiogram > or =2 months later.
Global wall motion score index decreased from 2.38 +/- 0.73 to 1.94 +/- 0.82 after revascularization (p < 0.001). Thirty-eight percent of severely dysfunctional segments recovered resting function. Compared to segments without recovery of resting function, those with recovery had greater EDWT (0.94 +/- 0.18 cm vs. 0.67 +/- 0.22 cm, p < or = 0.0001) and a higher T1-201 uptake (78 +/- 13% vs. 59 +/- 21%; p < 0.0001). An EDWT >0.6 cm had a sensitivity of 94% and specificity of 48% for recovery of function. Similarly, a T1-201 maximal uptake of > or =60% had a sensitivity of 91% and specificity of 50%. Receiver operating characteristic curves for prediction of recovery of regional and global function were similar for EDWT and maximum T1-201 uptake. Combination of EDWT and any contractile reserve during DSE for recovery of regional function improved the specificity to 77% without a significant loss in sensitivity (88%).
End-diastolic wall thickness is an important marker of myocardial viability in patients with suspected hibernation, and it can predict recovery of function similar to T1-201 scintigraphy. Importantly, a simple measurement of EDWT < or =0.6 cm virtually excludes the potential for recovery of function and is a valuable adjunct to DSE in the assessment of myocardial viability.
本研究评估了通过超声心动图测量的舒张末期室壁厚度（EDWT）是否为疑似心肌冬眠患者心肌存活的重要标志物，并将该指标与目前已确立的多巴酚丁胺负荷超声心动图（DSE）及静息-再分布铊-201（T1-201）心肌显像等诊断方法进行比较。
由于心肌坏死与心肌变薄相关，保留的EDWT可能提供一个简单的心肌存活指标，可从静息超声心动图中轻易获得。
因此，45例稳定型冠心病伴心室功能障碍患者在血运重建前接受了静息二维超声心动图、DSE及静息-再分布T1-201断层扫描，并在≥2个月后重复进行静息超声心动图检查。
血运重建后整体室壁运动评分指数从2.38±0.73降至1.94±0.82（p<0.001）。38%的严重功能障碍节段恢复了静息功能。与未恢复静息功能的节段相比，恢复功能的节段有更大的EDWT（0.94±0.18 cm对0.67±0.22 cm，p≤0.0001）和更高的T1-201摄取率（78±13%对59±21%；p<0.0001）。EDWT>0.6 cm对功能恢复的敏感性为94%，特异性为48%。同样，T1-201最大摄取率≥60%时，敏感性为91%，特异性为50%。EDWT和T1-201最大摄取率预测局部和整体功能恢复的受试者工作特征曲线相似。将EDWT与DSE期间的任何收缩储备相结合用于预测局部功能恢复，可将特异性提高到77%，而敏感性无显著降低（88%）。
舒张末期室壁厚度是疑似冬眠患者心肌存活的重要标志物，其预测功能恢复的能力与T1-201心肌显像相似。重要的是，简单测量EDWT≤0.6 cm实际上可排除功能恢复的可能性，在评估心肌存活方面是DSE的有价值辅助手段。
