Gjesdal Ola, Hopp Einar, Vartdal Trond, Lunde Ketil, Helle-Valle Thomas, Aakhus Svend, Smith Hans-Jørgen, Ihlen Halfdan, Edvardsen Thor
Department of Cardiology, Faculty of Medicine, University of Oslo/Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway.
Clin Sci (Lond). 2007 Sep;113(6):287-96. doi: 10.1042/CS20070066.
2D-STE (two-dimensional speckle tracking echocardiography) is a novel echocardiographic modality that enables angle-independent assessment of myocardial deformation indices. In the present study, we tested whether peak systolic epsilon(parallel) (longitudinal strain) values measured by 2D-STE could identify areas of MI (myocardial infarction) as determined by CE MRI (contrast-enhanced magnetic resonance imaging). Conventional echocardiographic apical long-axis recordings were performed in 38 patients, 9 months after a first MI. Peak systolic epsilon(parallel) measured by 2D-STE in 16 left ventricle segments was compared with segmental infarct mass and transmurality assessed by CE MRI. Segmental values were averaged to global and territorial values for assessment of global function and myocardial function in the coronary distribution areas. CE MRI identified transmural infarction in 27 patients, and a mean infarct size of 36+/-25 g. Peak systolic epsilon( parallel) correlated with the infarct mass at the global level (r=0.84, P<0.001). A strain value of -15% identified infarction with 83% sensitivity and 93% specificity at the global level and 76% and 95% at the territorial level, and a strain value of -13% identified transmural infarction with 80% sensitivity and 83% specificity at the segmental level. Global infarct mass correlates with the wall motion score index (r=0.70, P<0.001), and left ventricular ejection fraction measured by MRI or echocardiography (r=-0.71 and -0.58, both P<0.001). In chronic infarction, peak systolic epsilon(parallel) measured by 2D-STE correlates with the infarct mass assessed by CE MRI at a global level, and separates infarcted from non-infarcted tissue. Global strain is an excellent predictor of myocardial infarct size in chronic ischaemic heart disease.
二维斑点追踪超声心动图（2D-STE）是一种新型超声心动图检查方法，可实现心肌变形指数的角度无关评估。在本研究中，我们测试了通过2D-STE测量的收缩期峰值ε（平行）（纵向应变）值能否识别出由对比增强磁共振成像（CE MRI）确定的心肌梗死（MI）区域。对38例首次心肌梗死后9个月的患者进行了传统超声心动图心尖长轴记录。将通过2D-STE在16个左心室节段测量的收缩期峰值ε（平行）与CE MRI评估的节段梗死质量和透壁性进行比较。将节段值平均为整体和区域值，以评估整体功能和冠状动脉分布区域的心肌功能。CE MRI识别出27例透壁性梗死，平均梗死大小为36±25 g。收缩期峰值ε（平行）在整体水平与梗死质量相关（r = 0.84，P <0.001）。应变值-15%在整体水平识别梗死的敏感性为83%，特异性为93%，在区域水平为76%和95%，应变值-13%在节段水平识别透壁性梗死的敏感性为80%，特异性为83%。整体梗死质量与壁运动评分指数相关（r = 0.70，P <0.001），与通过MRI或超声心动图测量的左心室射血分数相关（r = -0.71和-0.58，均P <0.001）。在慢性梗死中，通过2D-STE测量的收缩期峰值ε（平行）在整体水平与CE MRI评估的梗死质量相关，并将梗死组织与非梗死组织区分开来。整体应变是慢性缺血性心脏病中心肌梗死大小的优秀预测指标。
