Eek Christian, Grenne Bjørnar, Brunvand Harald, Aakhus Svend, Endresen Knut, Smiseth Otto A, Edvardsen Thor, Skulstad Helge
Department of Cardiology, Rikshospitalet, Oslo University Hospital and University of Oslo, 0027 Oslo, Norway.
Eur J Echocardiogr. 2010 Jul;11(6):501-8. doi: 10.1093/ejechocard/jeq008. Epub 2010 Feb 25.
Patients with acute coronary occlusion may lack typical signs of myocardial infarction in the electrocardiogram. We tested the ability of different echocardiographic modalities to identify coronary occlusion by quantifying myocardial dysfunction in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS).
One hundred and fifty patients were examined by echocardiography immediately prior to coronary angiography, 2.2 +/- 0.7 days (mean +/- SD) after hospitalization for a first NSTE-ACS. Thirty-three patients (22%) had acute coronary occlusion. These patients had impaired left ventricular function as ejection fraction was reduced (54.9 +/- 9.6 vs. 59.1 +/- 7.6%, P = 0.02). Regional myocardial function was assessed in a 16-segment model by two methods: longitudinal strain by speckle tracking echocardiography and wall motion score (WMS) by visual assessment. Patients with acute coronary occlusion had an increased number of adjacent dysfunctional segments. The median size of the dysfunctional area by strain was 7 [inter-quartile range (IQR) 4.5-9] vs. 2 (IQR 0-5) segments (P < 0.001). An area of >or=4 adjacent dysfunctional segments (strain greater than or equal to -14%) had the best ability to identify patients with acute coronary occlusion, with sensitivity 85% and specificity 70%. WMS demonstrated slightly less accuracy than strain.
Strain echocardiography identifies NSTE-ACS patients with acute coronary occlusion, who may benefit from urgent reperfusion therapy.
急性冠状动脉闭塞患者的心电图可能缺乏心肌梗死的典型表现。我们通过量化非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者的心肌功能障碍，测试了不同超声心动图模式识别冠状动脉闭塞的能力。
150例患者在首次因NSTE-ACS住院后2.2±0.7天（平均±标准差）、冠状动脉造影前立即接受超声心动图检查。33例患者（22%）发生急性冠状动脉闭塞。这些患者的左心室功能受损，射血分数降低（54.9±9.6%对59.1±7.6%，P=0.02）。采用两种方法在16节段模型中评估局部心肌功能：斑点追踪超声心动图测量纵向应变和视觉评估室壁运动评分（WMS）。急性冠状动脉闭塞患者相邻功能障碍节段数量增加。应变法测得的功能障碍区域中位数大小为7个节段[四分位间距（IQR）4.5 - 9]，而WMS法为2个节段（IQR 0 - 5）（P<0.001）。≥4个相邻功能障碍节段（应变≥-14%）识别急性冠状动脉闭塞患者的能力最佳，敏感性为85%，特异性为70%。WMS的准确性略低于应变法。
应变超声心动图可识别可能从紧急再灌注治疗中获益的NSTE-ACS合并急性冠状动脉闭塞患者。
