Ng Arnold C T, Tran Da T, Newman Mark, Allman Christine, Vidaic Jane, Leung Dominic Y
Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia.
Am J Cardiol. 2008 Nov 1;102(9):1146-50. doi: 10.1016/j.amjcard.2008.06.033. Epub 2008 Aug 15.
Assessment of left ventricular (LV) dyssynchrony after myocardial infarction has prognostic value. There were no reference ranges for 2-dimensional (2D) speckle tracking synchrony, and it was unclear whether color tissue Doppler imaging and 2D speckle tracking synchrony indexes were comparable. One hundred twenty-two healthy volunteers and 40 patients with non-ST-elevation myocardial infarction (NSTEMI) had LV systolic and diastolic synchrony, defined as the SD of time to peak systolic (2D-SDTs) and early diastolic (2D-SDTe) velocities in the 12 basal and mid segments using 2D speckle tracking, respectively. Mean 2D-SDTs and 2D-SDTe were 29.4 +/- 16.1 and 14.2 +/- 6.1 ms in healthy subjects, respectively. Gender and mean 2D systolic velocity independently predicted 2D-SDTs, and mean 2D early diastolic velocity independently predicted 2D-SDTe. Bland-Altman analysis showed suboptimal agreement between 2D speckle tracking and tissue Doppler imaging dyssynchrony indexes. 2D speckle tracking showed lower coefficients of variation for time to peak systolic and early diastolic velocities than tissue Doppler imaging. There were no significant differences in coefficients of variation for 2D speckle tracking systolic and diastolic synchrony for high versus low frame rates. Patients with NSTEMI had significantly lower ejection fraction, but higher LV mass and wall stress than healthy subjects. Only 2D-SDTs was significantly higher in patients with NSTEMI compared with healthy subjects (37.1 +/- 22.5 vs 29.4 +/- 16.1 ms; p = 0.02). In conclusion, 2D-SDTs was gender specific and influenced by global systolic function, and 2D-SDTe was influenced by global diastolic function. 2D speckle tracking and tissue Doppler imaging dyssynchrony indexes were not comparable. 2D speckle tracking may be a more sensitive discriminator of LV systolic dyssynchrony than tissue Doppler imaging.
评估心肌梗死后左心室（LV）不同步具有预后价值。二维（2D）斑点追踪同步性没有参考范围，并且彩色组织多普勒成像和2D斑点追踪同步性指标是否具有可比性尚不清楚。122名健康志愿者和40例非ST段抬高型心肌梗死（NSTEMI）患者进行了LV收缩期和舒张期同步性评估，分别使用2D斑点追踪法测量12个基底段和中间段达到收缩期峰值（2D-SDTs）和舒张早期（2D-SDTe）速度的标准差来定义。健康受试者的平均2D-SDTs和2D-SDTe分别为29.4±16.1和14.2±6.1毫秒。性别和平均2D收缩期速度独立预测2D-SDTs，平均2D舒张早期速度独立预测2D-SDTe。Bland-Altman分析显示2D斑点追踪和组织多普勒成像不同步指标之间的一致性欠佳。2D斑点追踪显示收缩期峰值和舒张早期速度的变异系数低于组织多普勒成像。高帧频和低帧频下2D斑点追踪收缩期和舒张期同步性的变异系数无显著差异。NSTEMI患者的射血分数显著低于健康受试者，但左心室质量和壁应力更高。与健康受试者相比，NSTEMI患者仅2D-SDTs显著更高（37.1±22.5 vs 29.4±16.1毫秒；p=0.02）。总之，2D-SDTs具有性别特异性且受整体收缩功能影响，2D-SDTe受整体舒张功能影响。2D斑点追踪和组织多普勒成像不同步指标不具有可比性。2D斑点追踪可能是比组织多普勒成像更敏感的LV收缩期不同步鉴别方法。
