心肌梗死后局部收缩功能的量化：在区分梗死心肌和远隔心肌方面，应变分析优于室壁增厚分析。

Quantification of regional contractile function after infarction: strain analysis superior to wall thickening analysis in discriminating infarct from remote myocardium.

作者信息

Götte M J, van Rossum A C, Marcus J T, Visser C A

机构信息

Department of Cardiology, University Hospital, Vrije Universiteit, and Institute for Cardiovascular Research, Amsterdam, The Netherlands.

出版信息

J Am Coll Cardiol. 2001 Mar 1;37(3):808-17. doi: 10.1016/s0735-1097(00)01186-4.

DOI:10.1016/s0735-1097(00)01186-4

PMID:11693756

Abstract

OBJECTIVES

Using two-dimensional wall thickening (WT) (expressed as percentage) and strain analysis, regional contractile myocardial function was quantified and compared in 13 control subjects and 13 patients with a first myocardial infarction (MI). The findings in the patient group were related to global ventricular function and infarct size.

BACKGROUND

In patients with coronary artery disease, regions with dysfunctional myocardium cannot be differentiated easily from regions with normal function by planar WT analysis. Physiologic factors, in combination with limitations of conventional imaging techniques, affect the calculation of WT. Quantitative assessment of contractile function by magnetic resonance (MR) tissue tagging and strain analysis may be less affected by these factors.

METHODS

Two-dimensional regional WT and strain were calculated in three short-axis MR cine and tagged images, respectively. Left ventricular volumes and ejection fraction (EF) were obtained from a series of contiguous short-axis cine images.

RESULTS

In patients with infarct-related ventricles, WT and strain analysis both revealed reduced myocardial function, as compared with control subjects (p < 0.005 and p < 0.001, respectively). However, WT analysis yielded no significant regional differences in function between infarct-related and remote myocardium (p = 0.064), whereas strain analysis did (p < 0.005). For detecting dysfunctional myocardium of electrocardiographically and angiographically defined infarct areas, WT analysis had a sensitivity of 69% and a specificity of 92%, whereas strain analysis demonstrated a sensitivity of 92% and a specificity of 99%. The EF correlated with WT (r = 0.76, p < 0.005) and strain (r = 0.89, p < 0.001).

CONCLUSIONS

Two-dimensional strain analysis is more accurate than planar WT analysis in discriminating dysfunctional from functional myocardium, and it provides a strong correlation between regional myocardial and global ventricular function.

摘要

目的

运用二维壁增厚（WT）（以百分比表示）和应变分析，对13名对照受试者和13名首次心肌梗死（MI）患者的局部心肌收缩功能进行量化并比较。患者组的研究结果与整体心室功能及梗死面积相关。

背景

在冠心病患者中，通过平面WT分析难以轻易区分心肌功能异常区域和正常功能区域。生理因素与传统成像技术的局限性共同影响WT的计算。磁共振（MR）组织标记和应变分析对收缩功能的定量评估可能受这些因素的影响较小。

方法

分别在三个短轴MR电影和标记图像中计算二维局部WT和应变。从一系列连续的短轴电影图像中获取左心室容积和射血分数（EF）。

结果

与对照受试者相比，梗死相关心室患者的WT和应变分析均显示心肌功能降低（分别为p < 0.005和p < 0.001）。然而，WT分析显示梗死相关心肌和远隔心肌之间在功能上无显著区域差异（p = 0.064），而应变分析有显著差异（p < 0.005）。对于检测心电图和血管造影确定的梗死区域的功能异常心肌，WT分析的敏感性为69%，特异性为92%，而应变分析的敏感性为92%，特异性为99%。EF与WT（r = 0.76，p < 0.005）和应变（r = 0.89，p < 0.001）相关。