右心室心肌梗死及右冠状动脉近端病变识别中的新参数
New parameters in identification of right ventricular myocardial infarction and proximal right coronary artery lesion.
作者信息
Ozdemir Kurtuluş, Altunkeser Bülent B, Içli Abdullah, Ozdil Hüseyin, Gök Hasan
机构信息
Cardiology Department, Selçuk University Medical Faculty, Konya, Turkey.
出版信息
Chest. 2003 Jul;124(1):219-26. doi: 10.1378/chest.124.1.219.
OBJECTIVE
The diagnosis of right ventricular myocardial infarction (RVMI) accompanied by acute inferior myocardial infarction (MI) is still a problem that we encounter. This study was designed to find out the usefulness both of peak myocardial systolic velocity (Sm) and of the myocardial performance index (MPI) of the right ventricle measured by pulsed-wave tissue Doppler imaging (TDI) in assessing right ventricular function.
METHODS
Sixty patients who experienced a first acute inferior MI (mean [+/- SD] age, 57 +/- 9 years) were prospectively assessed. An ST-segment elevation of >or= 0.1 mV in V(4)-V(6)R lead derivations was defined as an RVMI. From the echocardiographic apical four-chamber view, the Sm, the peak early diastolic velocity, peak late diastolic velocity, the ejection time, the isovolumetric relaxation time, and the contraction time of the right ventricle were recorded at the level of the tricuspid annulus by using TDI. Then, the MPI was calculated. The patients were classified into the following three groups, according to the localization of the infarct-related artery (IRA) detected using coronary angiography: group I, proximal right coronary artery; group II, distal right coronary artery; and group III, circumflex coronary artery.
RESULTS
RVMIs were detected in sixteen patients, and the IRA in 27 patients was the proximal right coronary artery. The right ventricular Sm was observed to be significantly low in patients with RVMIs and those in group I compared to those without RVMIs and those in groups II and III (10.9 +/- 1.3 vs 14.3 +/- 3.2 cm/s, respectively [p < 0.001]; 11.5 +/- 2.5 vs 15.1 +/- 3 cm/s, respectively; and 14.9 +/- 2.6 cm/s, respectively [p < 0.001]). In the diagnosis of RVMI, the values for sensitivity, specificity, negative predictive value, and positive predictive value of Sm < 12 cm/s were 81%, 82%, 92%, and 62% respectively, and in the diagnosis of the proximal right coronary artery as the IRA, those values were 63%, 88%, 74%, and 81%, respectively. The MPI was high in the same patient groups (0.83 +/- 0.12 vs 0.57 +/- 0.11 in those patients without RVMI, respectively, [p < 0.001]; 0.74 +/- 0.13 vs 0.56 +/- 0.15 in group II and 0.54 +/- 0.07 in group III, respectively [p < 0.001]). The sensitivity, specificity, negative predictive value, and positive predictive value of an MPI of > 0.70 in the diagnosis of RVMI were calculated as 94%, 80%, 97%, and 63%, respectively, and in the diagnosis of the proximal right coronary artery as the IRA, those values were 78%, 91%, 83%, and 88% respectively.
CONCLUSIONS
An Sm <12 cm/s and an MPI > 0.70 obtained by TDI may define RVMI concomitant with acute inferior MI, and the IRA.
目的
右心室心肌梗死（RVMI）合并急性下壁心肌梗死（MI）的诊断仍是我们面临的一个问题。本研究旨在探讨脉冲波组织多普勒成像（TDI）测量的右心室心肌收缩期峰值速度（Sm）和心肌性能指数（MPI）在评估右心室功能方面的实用性。
方法
对60例首次发生急性下壁MI（平均[±标准差]年龄，57±9岁）的患者进行前瞻性评估。V（4）-V（6）R导联ST段抬高≥0.1 mV定义为RVMI。从超声心动图心尖四腔视图，使用TDI在三尖瓣环水平记录右心室的Sm、舒张早期峰值速度、舒张晚期峰值速度、射血时间、等容舒张时间和收缩时间。然后，计算MPI。根据冠状动脉造影检测到的梗死相关动脉（IRA）的位置，将患者分为以下三组：第一组，右冠状动脉近端；第二组，右冠状动脉远端；第三组，回旋支冠状动脉。
结果
16例患者检测到RVMI，27例患者的IRA为右冠状动脉近端。与无RVMI的患者以及第二组和第三组的患者相比，RVMI患者和第一组患者的右心室Sm明显较低（分别为10.9±1.3 vs 14.3±3.2 cm/s [p<0.001]；分别为11.5±2.5 vs 15.1±3 cm/s；以及分别为14.9±2.6 cm/s [p<0.001]）。在RVMI的诊断中，Sm<12 cm/s的敏感性、特异性、阴性预测值和阳性预测值分别为81%、82%、92%和62%，在诊断IRA为右冠状动脉近端时，这些值分别为63%、88%、74%和81%。相同患者组的MPI较高（无RVMI的患者分别为0.83±0.12 vs 0.57±0.11 [p<0.001]；第二组分别为0.74±0.13 vs 0.56±0.15，第三组为0.54±0.07 [p<0.001]）。诊断RVMI时，MPI>0.70的敏感性、特异性、阴性预测值和阳性预测值分别计算为94%、80%、97%和63%，在诊断IRA为右冠状动脉近端时，这些值分别为78%、91%、83%和88%。
结论
TDI获得的Sm<12 cm/s和MPI>0.70可能有助于定义合并急性下壁MI的RVMI以及IRA。
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