Department of Medicine, University of Queensland, Brisbane, Australia.
JACC Cardiovasc Imaging. 2010 Feb;3(2):121-31. doi: 10.1016/j.jcmg.2009.09.025.
Comparison of myocardial tissue-velocity imaging (TVI) and speckle-tracking echocardiography (STE) for prediction of viability at dobutamine echocardiography (DbE).
Use of TVI-based strain imaging during DbE may facilitate the prediction of myocardial viability but has technical limitations. STE overcomes these but requires evaluation for prediction of viability.
We studied 55 patients with ischemic heart disease and left ventricular systolic dysfunction (left ventricular ejection fraction <0.45) who were undergoing DbE for assessment of myocardial viability and who subsequently underwent myocardial revascularization. TVI was used to measure longitudinal end-systolic strain (longS) and peak systolic strain rate (SR) at rest and at low-dose dobutamine (LDD). Longitudinal, radial, and circumferential strain and strain rate were measured with STE. Segmental functional recovery was defined by improved wall-motion score on side-by-side comparison of echocardiographic images before and 9 months after revascularization and areas under the receiver operator characteristic curves were used to compare methods.
Of the 375 segments with abnormal resting function, 154 (41%) showed functional recovery. Only circumferential resting and low-dose STE strain and low-dose longitudinal strain and SR predicted functional recovery independent of wall-motion analysis. Among different strain parameters, only TVI-based longitudinal end-systolic strain and peak systolic SR at LDD had incremental value over wall-motion analysis (areas under the receiver operator characteristic curves of 0.79, 0.79, and 0.74, respectively). STE measurements of strain and SR identified viability only in the anterior circulation, whereas TVI strain and SR accurately identified viability in both anterior and posterior circulations.
Combination of TVI or STE methods with DbE can predict viability, with TVI strain and SR at LDD being the most accurate. TVI measures can predict viability in both anterior and posterior circulations, but STE measurements predict viability only in the anterior circulation.
比较心肌组织速度成像（TVI）和斑点追踪超声心动图（STE）在多巴酚丁胺超声心动图（DbE）中预测存活心肌的能力。
在 DbE 期间使用基于 TVI 的应变成像可能有助于预测存活心肌，但存在技术限制。STE 克服了这些限制，但需要进行评估以预测存活心肌。
我们研究了 55 例缺血性心脏病和左心室收缩功能障碍（左心室射血分数<0.45）患者，这些患者正在接受 DbE 评估存活心肌，并随后接受了心肌血运重建。TVI 用于测量静息和低剂量多巴酚丁胺（LDD）时的纵向收缩末期应变（longS）和收缩期应变率（SR）。STE 用于测量纵向、径向和环向应变和应变率。通过比较血管重建前后 9 个月的超声心动图图像，通过改善壁运动评分来定义节段功能恢复，并用接收者操作特征曲线下面积来比较方法。
在 375 个静息功能异常的节段中，有 154 个（41%）节段出现功能恢复。只有环向静息和低剂量 STE 应变以及低剂量纵向应变和 SR 可以独立于壁运动分析预测功能恢复。在不同的应变参数中，只有 TVI 基的纵向收缩末期应变和 LDD 时的收缩期峰值 SR 具有比壁运动分析更高的价值（接收者操作特征曲线下面积分别为 0.79、0.79 和 0.74）。STE 测量的应变和 SR 仅在前循环中识别存活心肌，而 TVI 应变和 SR 则准确地识别了前循环和后循环中的存活心肌。
将 TVI 或 STE 方法与 DbE 相结合可以预测存活心肌，其中 LDD 的 TVI 应变和 SR 最准确。TVI 测量可以预测前循环和后循环中的存活心肌，但 STE 测量仅在前循环中预测存活心肌。
