Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Am J Cardiol. 2010 Mar 1;105(5):592-7. doi: 10.1016/j.amjcard.2009.10.039. Epub 2010 Jan 22.
This study examined the prognostic value of novel diastolic indexes in ST-elevation acute myocardial infarction (AMI), derived from strain and strain rate analysis using 2-dimensional speckle tracking imaging. Echocardiograms were obtained within 48 hours of admission in 371 consecutive patients with first ST-elevation AMI (59.7 +/- 11.6 years old). Indexes of diastolic function including mean strain rate during isovolumic relaxation (SR(IVR)), mean early diastolic strain rate (SR(E)) and mean diastolic strain at peak transmitral E wave (E) were obtained from 3 apical views. Mean early diastolic velocity from 4 basal segments by color-coded tissue Doppler imaging was measured. Indexes of diastolic filling including E/SR(IVR), E/SR(E), E/diastolic strain at E, and E/early diastolic velocity were calculated. The primary end point (composite of death, hospitalization for heart failure, repeat MI, and repeat revascularization) occurred in 84 patients (22.6%) during a mean follow-up of 17.3 +/- 12.2 months. Mean SR(IVR) (p <0.001), multivessel disease (p <0.001), Thrombolysis In Myocardial Infarction grade 0 to 1 flow after percutaneous coronary intervention (p = 0.004), and left ventricular ejection fraction (p = 0.008) were independent predictors of the combined end point on Cox regression analysis. Mean SR(IVR) showed incremental prognostic value over baseline clinical and echocardiographic variables (global chi-square increase from 41.0 to 51.6, p <0.001). After dividing patient population based on median SR(IVR), patients with SR(IVR) < or =0.24/second had significantly higher event rates than others (hazard ratio 2.74, 95% confidence interval 1.61 to 4.67, p <0.001). In conclusion, SR(IVR) was incremental to left ventricular ejection fraction, Thrombolysis In Myocardial Infarction grade 0 to 1 flow after percutaneous coronary intervention, and multivessel disease and superior to other diastolic indexes in predicting future cardiovascular events after AMI. SR(IVR) may be useful in identifying high-risk patients soon after AMI.
这项研究使用二维斑点追踪成像技术从应变和应变速率分析中得出了新的舒张指数，探讨了这些指数在 ST 段抬高急性心肌梗死（AMI）中的预后价值。连续纳入 371 例首次发生 ST 段抬高 AMI 的患者（59.7±11.6 岁），于入院后 48 小时内行超声心动图检查。从 3 个心尖切面获得舒张功能指数，包括等容舒张期平均应变率（SR(IVR)）、早期舒张期平均应变率（SR(E)）和峰值二尖瓣 E 波舒张期平均应变（E）。通过彩色组织多普勒成像测量 4 个基底段的早期舒张速度。计算舒张充盈指数，包括 E/SR(IVR)、E/SR(E)、E 在 E 波时的舒张期应变、E/早期舒张速度。主要终点（死亡、因心力衰竭住院、再次心肌梗死和再次血运重建的复合终点）发生于 84 例患者（22.6%），平均随访 17.3±12.2 个月。多因素 Cox 回归分析显示，SR(IVR)平均值（p<0.001）、多支血管病变（p<0.001）、经皮冠状动脉介入治疗后心肌梗死溶栓分级 0-1 级血流（p=0.004）和左心室射血分数（p=0.008）为复合终点的独立预测因子。SR(IVR)平均值较基线临床和超声心动图变量增加了预后价值（全局卡方值从 41.0 增加至 51.6，p<0.001）。根据 SR(IVR)中位数将患者人群分组后，SR(IVR)≤0.24/秒的患者事件发生率明显高于其他患者（风险比 2.74，95%置信区间 1.61 至 4.67，p<0.001）。结论：SR(IVR)是除左心室射血分数、经皮冠状动脉介入治疗后心肌梗死溶栓分级 0-1 级血流和多支血管病变以外的预测 AMI 后未来心血管事件的额外指标，优于其他舒张指标。SR(IVR)可能有助于在 AMI 后不久识别高危患者。
