Vartdal Trond, Brunvand Harald, Pettersen Eirik, Smith Hans-Jørgen, Lyseggen Erik, Helle-Valle Thomas, Skulstad Helge, Ihlen Halfdan, Edvardsen Thor
Department of Cardiology, Rikshospitalet University Hospital, University of Oslo, Oslo, Norway.
J Am Coll Cardiol. 2007 Apr 24;49(16):1715-21. doi: 10.1016/j.jacc.2006.12.047. Epub 2007 Apr 5.
The objective of this study was to investigate whether strain Doppler echocardiography performed immediately after revascularization by percutaneous coronary intervention could predict the extent of myocardial scar, determined by contrast-enhanced magnetic resonance imaging (MRI).
There is considerable variability in survival rate after percutaneous coronary intervention, and accurate early risk stratification is therefore of major clinical importance.
Thirty individuals with acute anterior myocardial infarction were examined with longitudinal strain by Doppler 1.5 h after revascularization. The extent of scarring 9 months later was analyzed by MRI in 16 corresponding myocardial segments. Strain in all left ventricular segments was averaged to obtain a global value. Infarct size was estimated by clinical parameters and cardiac markers.
A good correlation was found between the global strain and total infarct size (R = 0.77, p < 0.00001). A multivariate regression analysis showed that global peak strain and serum glutamic oxaloacetic transaminase correlated with the infarct size measured by MRI (p = 0.0001 and p = 0.001, respectively). Furthermore, a clear inverse relationship was found between the segmental strain and the transmural extent of infarction in each segment (R = 0.67, p < 0.0001).
This study demonstrates that assessment of regional and global strain at 1.5 h after reperfusion therapy correlates with size and transmural extent of myocardial infarction as determined by contrast-enhanced MRI. The novel global strain parameter is a valuable predictor of the total extent of myocardial infarction and may therefore be an important clinical tool for risk stratification in the acute phase of myocardial infarction.
本研究旨在探讨经皮冠状动脉介入治疗血管重建术后立即进行应变多普勒超声心动图检查是否能够预测由对比增强磁共振成像（MRI）测定的心肌瘢痕范围。
经皮冠状动脉介入治疗后的生存率存在很大差异，因此准确的早期风险分层具有重要的临床意义。
对30例急性前壁心肌梗死患者在血管重建术后1.5小时进行多普勒纵向应变检查。9个月后通过MRI分析16个相应心肌节段的瘢痕形成程度。将所有左心室节段的应变进行平均以获得一个整体值。通过临床参数和心脏标志物估计梗死面积。
发现整体应变与总梗死面积之间存在良好的相关性（R = 0.77，p < 0.00001）。多变量回归分析显示，整体峰值应变和血清谷草转氨酶与MRI测量的梗死面积相关（分别为p = 0.0001和p = 0.001）。此外，在每个节段中，节段应变与梗死透壁程度之间发现明显的负相关关系（R = 0.67，p < 0.0001）。
本研究表明，再灌注治疗后1.5小时对局部和整体应变的评估与对比增强MRI测定的心肌梗死大小和透壁程度相关。新的整体应变参数是心肌梗死总范围的有价值预测指标，因此可能是心肌梗死急性期风险分层的重要临床工具。
