Witt Nils, Alam Mahbubul, Svensson Leif, Samad Bassem A
Department of Cardiology, Karolinska Institute at South Hospital Södersjukhuset, Stockholm, Sweden.
Echocardiography. 2010 Feb;27(2):139-45. doi: 10.1111/j.1540-8175.2009.00985.x. Epub 2009 Aug 31.
Right ventricular (RV) involvement in patients with ST elevation myocardial infarction (STEMI) is a clinically important problem. The aim of this study was to evaluate the use of tricuspid annular velocity assessed by Doppler tissue imaging (DTI) as a marker of RV involvement in patients with a first STEMI.
Seventy-one patients with a first STEMI were examined by echocardiography before discharge and after 6 months. The patients were compared to 31 healthy subjects (HS). The diagnosis of RV infarction was based on the presence of >or= 1 mm ST elevation in the right precordial ECG lead V4R. Tricuspid annular systolic and diastolic velocities using pulsed-wave DTI were recorded at the RV free wall.
At day 1, tricuspid annular velocities were significantly reduced in patients with, compared to those without, ST elevation in V4R (11.1 vs. 13.7 cm/sec, 9.4 vs. 13.1 cm/sec and 14.1 vs. 15.9 cm/sec for systolic, early, and late diastolic velocities, respectively; P < 0.01). With a cutoff value for a tricuspid annular systolic velocity of 13 cm/sec, sensitivity and specificity for identifying patients with ST elevation in V4R were 89% and 71%, respectively. After 6 months, both tricuspid annular systolic and diastolic velocities in patients with RV infarction had increased significantly, but only tricuspid annular systolic velocity was still reduced compared to HS (12.3 vs. 14.7 cm/sec; P < 0.01).
Tricuspid annular velocities assessed by DTI may be used as a marker of RV involvement in the acute and the late phase after a first STEMI.
右心室（RV）受累在ST段抬高型心肌梗死（STEMI）患者中是一个具有临床重要性的问题。本研究的目的是评估通过多普勒组织成像（DTI）测量的三尖瓣环速度作为首次STEMI患者右心室受累标志物的应用价值。
对71例首次STEMI患者在出院前和6个月后进行超声心动图检查。将这些患者与31名健康受试者（HS）进行比较。右心室梗死的诊断基于右胸前心电图导联V4R中ST段抬高≥1mm。使用脉冲波DTI记录右心室游离壁处的三尖瓣环收缩期和舒张期速度。
在第1天，与V4R无ST段抬高的患者相比，V4R有ST段抬高的患者三尖瓣环速度显著降低（收缩期速度分别为11.1对13.7cm/秒，舒张早期速度为9.4对13.1cm/秒，舒张晚期速度为14.1对15.9cm/秒；P<0.01）。以三尖瓣环收缩期速度13cm/秒为临界值，识别V4R有ST段抬高患者的敏感性和特异性分别为89%和71%。6个月后，右心室梗死患者的三尖瓣环收缩期和舒张期速度均显著增加，但与健康受试者相比，仅三尖瓣环收缩期速度仍降低（12.3对14.7cm/秒；P<0.01）。
通过DTI评估的三尖瓣环速度可作为首次STEMI后急性期和晚期右心室受累的标志物。
