经多普勒心肌成像检测到的收缩期后增厚：心肌梗死患者存活或缺血的标志物。
Postsystolic thickening detected by Doppler myocardial imaging: a marker of viability or ischemia in patients with myocardial infarction.
作者信息
Song Jae-Kwan, Song Jong-Min, Kang Duk-Hyun, Haluska Brian, Marwick Thomas H
机构信息
Division of Cardiology, Asan Medical Center, Seoul, South Korea.
出版信息
Clin Cardiol. 2004 Jan;27(1):29-32. doi: 10.1002/clc.4960270108.
BACKGROUND
Postsystolic thickening (PST) of ischemic myocardial segments has been reported to account for the characteristic heterogeneity or regional asynchrony of myocardial wall motion during acute ischemia.
HYPOTHESIS
Postsystolic thickening detected by Doppler myocardial imaging (DMI) could be a useful clinical index of myocardial viability or peri-infarction viability in patients with myocardial infarction (MI).
METHODS
Doppler myocardial imaging was recorded at each stage of a standard dobutamine stress echocardiogram (DSE) in 20 patients (16 male, 60 +/- 13 years) with an MI in the territory of the left anterior descending artery. Myocardial velocity data were measured in the interventricular septum and apical inferior segment of the MI territory. Postsystolic thickening was identified if the absolute velocity of PST was higher than peak systolic velocity in the presence of either a resting PST > 2.0 cm/s or if PST doubled at low-dose dobutamine infusion.
RESULTS
Doppler myocardial imaging data could be analyzed in 38 ischemic segments (95%), and PST was observed in 21 segments (55%), including 3 segments showing PST only at low-dose dobutamine infusion. There was no significant difference of baseline wall motion score index (2.1 +/- 0.3 vs. 2.1 +/- 0.6, p = 0.77) or peak systolic velocity (1.1 +/- 1.1 vs. 1.9 +/- 2.0 cm/s, p = 0.05) between segments with and without PST. Peri-infarction ischemia or viability during DSE was more frequently observed in segments with PST than in those without (86 vs. 24%, p < 0.05). The sensitivity and specificity of PST for prediction of peri-infarction viability or ischemia was 82 and 81%, respectively.
CONCLUSIONS
Postsystolic thickening in the infarct territory detected by DMI is closely related with peri-infarction ischemia or viability at DSE.
背景
据报道，缺血心肌节段的收缩期后增厚（PST）是急性缺血期间心肌壁运动特征性异质性或区域不同步的原因。
假设
通过多普勒心肌成像（DMI）检测到的收缩期后增厚可能是心肌梗死（MI）患者心肌存活或梗死周边存活的有用临床指标。
方法
对20例（16例男性，年龄60±13岁）左前降支区域发生MI的患者，在标准多巴酚丁胺负荷超声心动图（DSE）的每个阶段记录多普勒心肌成像。在MI区域的室间隔和心尖下节段测量心肌速度数据。如果静息时PST>2.0 cm/s，或者在低剂量多巴酚丁胺输注时PST加倍，且PST的绝对速度高于收缩期峰值速度，则判定存在收缩期后增厚。
结果
38个缺血节段（95%）的多普勒心肌成像数据可进行分析，21个节段（55%）观察到PST，其中3个节段仅在低剂量多巴酚丁胺输注时显示PST。有PST和无PST的节段之间，基线壁运动评分指数（2.1±0.3对2.1±0.6，p = 0.77）或收缩期峰值速度（1.1±1.1对1.9±2.0 cm/s，p = 0.05）无显著差异。与无PST的节段相比，有PST的节段在DSE期间梗死周边缺血或存活更常见（86%对24%，p<0.05）。PST预测梗死周边存活或缺血的敏感性和特异性分别为82%和81%。
结论
DMI检测到的梗死区域收缩期后增厚与DSE时梗死周边缺血或存活密切相关。
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