Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
J Am Soc Echocardiogr. 2010 Apr;23(4):432-8. doi: 10.1016/j.echo.2010.01.018. Epub 2010 Mar 3.
The aim of this study was to investigate the changes and time course of recovery of regional myocardial function within the first week following successful primary coronary intervention in patients with first-time ST-segment elevation myocardial infarctions using myocardial deformation analysis, which is more quantitative and thus more objective than the wall motion score.
Thirty-one consecutive patients admitted with ST-segment elevation myocardial infarctions were studied on days 1, 2, 3, and 7 using strain and strain rate tissue Doppler echocardiography.
The mean peak troponin T level was 7.0 microg/L, and 15 patients had anterior and 16 had inferior infarct localization. Peak systolic strain rate and end-systolic strain increased significantly on day 2, both in segments with moderately reduced function (-0.6 to -1.0 s(-1) vs -8% to -15%, P < .001) and in severely reduced function (-0.2 to -1.0 s(-1) vs 1% to -12%, P < .001), but there were no further changes. Mean wall motion score in infarct related segments decreased significantly from day 1 to day 2 (2.7 to 2.4, P = .001) and from day 3 to day 7 (2.3 to 2.2, P = .001).
Recovery of regional function after ST-segment elevation myocardial infarction occurred within 2 days and could be detected by wall motion score, strain rate, and strain. However, strain and strain rate were better discriminative parameters for the changes in function as well as being better to assess near normalization on day 2. This could have a clinical impact on early management in patients who undergo percutaneous coronary intervention.
本研究旨在通过心肌变形分析来探讨首次 ST 段抬高型心肌梗死患者经成功的直接经皮冠状动脉介入治疗后，在最初一周内心肌局部功能的变化和恢复过程，心肌变形分析比壁运动评分更具定量性和客观性。
连续入选 31 例首次 ST 段抬高型心肌梗死患者，于第 1、2、3 和 7 天采用应变和应变率组织多普勒超声心动图进行研究。
肌钙蛋白 T 峰值平均水平为 7.0μg/L，15 例患者为前壁梗死，16 例为下壁梗死。第 2 天，中等程度收缩功能降低（-0.6 至-1.0s(-1) 与-8%至-15%，P<0.001）和严重收缩功能降低（-0.2 至-1.0s(-1) 与 1%至-12%，P<0.001）节段的收缩期应变率和收缩末期应变明显增加，但无进一步变化。梗死相关节段的平均壁运动评分从第 1 天至第 2 天（2.7 至 2.4，P=0.001）和从第 3 天至第 7 天（2.3 至 2.2，P=0.001）显著降低。
ST 段抬高型心肌梗死发生后，局部功能的恢复在 2 天内发生，可通过壁运动评分、应变率和应变来检测。然而，应变和应变率是评估功能变化的更好的区分性参数，并且在第 2 天更能评估接近正常化。这可能对接受经皮冠状动脉介入治疗的患者的早期管理产生临床影响。
