Department of Cardiology, Rikshospitalet University Hospital and University of Oslo, Oslo, Norway.
JACC Cardiovasc Imaging. 2010 Mar;3(3):247-56. doi: 10.1016/j.jcmg.2009.11.012.
OBJECTIVES: The aim of this study was to investigate whether myocardial strain echocardiography can predict ventricular arrhythmias in patients after myocardial infarction (MI). BACKGROUND: Left ventricular (LV) ejection fraction (EF) is insufficient for selecting patients for implantable cardioverter-defibrillator (ICD) therapy after MI. Electrical dispersion in infarcted myocardium facilitates malignant arrhythmia. Myocardial strain by echocardiography can quantify detailed regional and global myocardial function and timing. We hypothesized that electrical abnormalities in patients after MI will lead to LV mechanical dispersion, which can be measured as regional heterogeneity of contraction by myocardial strain. METHODS: We prospectively included 85 post-MI patients, 44 meeting primary and 41 meeting secondary ICD prevention criteria. After 2.3 years (range 0.6 to 5.5 years) of follow-up, 47 patients had no and 38 patients had 1 or more recorded arrhythmias requiring appropriate ICD therapy. Longitudinal strain was measured by speckle tracking echocardiography. The SD of time to maximum myocardial shortening in a 16-segment LV model was calculated as a parameter of mechanical dispersion. Global strain was calculated as average strain in a 16-segment LV model. RESULTS: The EF did not differ between ICD patients with and without arrhythmias occurring during follow-up (34 +/- 11% vs. 35 +/- 9%, p = 0.70). Mechanical dispersion was greater in ICD patients with recorded ventricular arrhythmias compared with those without (85 +/- 29 ms vs. 56 +/- 13 ms, p < 0.001). By Cox regression, mechanical dispersion was a strong and independent predictor of arrhythmias requiring ICD therapy (hazard ratio: 1.25 per 10-ms increase, 95% confidence interval: 1.1 to 1.4, p < 0.001). In patients with an EF >35%, global strain showed better LV function in those without recorded arrhythmias (-14.0% +/- 4.0% vs. -12.0 +/- 3.0%, p = 0.05), whereas the EF did not differ (44 +/- 8% vs. 41 +/- 5%, p = 0.23). CONCLUSIONS: Mechanical dispersion was more pronounced in post-MI patients with recurrent arrhythmias. Global strain was a marker of arrhythmias in post-MI patients with relatively preserved ventricular function. These novel parameters assessed by myocardial strain may add important information about susceptibility for ventricular arrhythmias after MI.
目的：本研究旨在探讨心肌应变超声心动图能否预测心肌梗死后（MI）患者的室性心律失常。
背景：左心室（LV）射血分数（EF）不足以选择 MI 后植入式心脏复律除颤器（ICD）治疗的患者。梗死心肌中的电弥散促进恶性心律失常。超声心动图心肌应变成像可以定量评估详细的局部和整体心肌功能和时间。我们假设 MI 后患者的电异常会导致 LV 机械弥散，这可以通过心肌应变测量收缩的局部异质性来衡量。
方法：我们前瞻性纳入 85 例 MI 后患者，44 例符合主要 ICD 预防标准，41 例符合次要 ICD 预防标准。经过 2.3 年（0.6-5.5 年）的随访，47 例患者无心律失常记录，38 例患者记录 1 次或多次需要适当 ICD 治疗的心律失常。纵向应变通过斑点追踪超声心动图测量。计算 16 节段 LV 模型中最大心肌缩短时间的标准差作为机械弥散的参数。整体应变通过 16 节段 LV 模型的平均应变计算。
结果：ICD 患者在随访期间发生和未发生心律失常的 EF 无差异（34 +/- 11% vs. 35 +/- 9%，p = 0.70）。与无心律失常记录的患者相比，有记录的室性心律失常的 ICD 患者机械弥散更大（85 +/- 29 ms vs. 56 +/- 13 ms，p < 0.001）。通过 Cox 回归，机械弥散是心律失常需要 ICD 治疗的强烈且独立的预测因子（每增加 10ms 的风险比：1.25，95%置信区间：1.1 至 1.4，p < 0.001）。在 EF >35%的患者中，无心律失常记录的患者的整体应变显示出更好的 LV 功能（-14.0% +/- 4.0% vs. -12.0 +/- 3.0%，p = 0.05），而 EF 无差异（44 +/- 8% vs. 41 +/- 5%，p = 0.23）。
结论：MI 后反复发作心律失常患者的机械弥散更为明显。整体应变是 MI 后心室功能相对保留患者心律失常的标志物。通过心肌应变评估的这些新参数可能为 MI 后室性心律失常的易感性提供重要信息。
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