慢性缺血性心肌病患者梗死周边区的纵向力学与室性心动过速诱导性。

Longitudinal mechanics of the periinfarct zone and ventricular tachycardia inducibility in patients with chronic ischemic cardiomyopathy.

机构信息

Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.

出版信息

Am Heart J. 2010 Oct;160(4):729-36. doi: 10.1016/j.ahj.2010.06.041.

DOI:10.1016/j.ahj.2010.06.041

PMID:20934568

Abstract

BACKGROUND

Quantification of segmental left ventricular (LV) strain by speckle-tracking echocardiography can identify transmural infarcts in patients with chronic ischemic cardiomyopathy. The aim of the study was to explore the relationship between the LV longitudinal peak systolic strain (LPSS) of the infarct, periinfarct, and remote zones and monomorphic ventricular tachycardia (VT) inducibility on electrophysiologic (EP) study.

METHODS

A total of 134 patients with chronic ischemic cardiomyopathy scheduled for EP study were included. The protocol consisted of clinical, electrocardiographic, and echocardiographic evaluation, including LV longitudinal strain analysis using speckle-tracking echocardiography, immediately before EP study. An infarct segment was defined as a longitudinal strain value of greater than -5%, and a periinfarct segment was defined as immediately adjacent to an infarct segment.

RESULTS

The infarct zone had the most impaired longitudinal strain (-0.5% ± 3.0%), whereas the periinfarct and remote zones had more preserved longitudinal strain (-10.8% ± 1.9% and -14.5% ± 3.0%, respectively; analysis of variance, P < .001). Seventy-two (54%) patients had inducible monomorphic VT on EP study. There was no significant difference in LV ejection fraction (31% ± 9% vs 32% ± 11%, P = .29) between inducible and noninducible patients. Longitudinal peak systolic strain of the periinfarct zone was more impaired in inducible patients (-9.8% ± 1.5% vs -11.0% ± 2.1%, P = .001), but no differences in LPSS of the infarct (-0.5% ± 3.2% vs -0.4% ± 2.7%, P = .75) and remote (-14.6% ± 2.8% vs -14.5% ± 3.4%, P = .92) zones were observed. Only LPSS of the periinfarct zone (OR 1.43, 95% CI 1.15-1.78, P = .001) was independently related to monomorphic VT inducibility on multiple logistic regression.

CONCLUSIONS

Longitudinal strain analysis may be a useful imaging tool to risk stratify ischemic patients for malignant ventricular arrhythmia.

摘要

背景

斑点追踪超声心动图定量分析节段性左心室（LV）应变可识别慢性缺血性心肌病患者的透壁性梗死。本研究旨在探讨梗死、梗死周边和远隔区的 LV 纵向收缩峰值应变（LPSS）与电生理（EP）研究中单形性室性心动过速（VT）诱发性之间的关系。

方法

共纳入 134 例拟行 EP 研究的慢性缺血性心肌病患者。方案包括临床、心电图和超声心动图评估，包括 EP 研究前使用斑点追踪超声心动图进行 LV 纵向应变分析。梗死节段定义为纵向应变值大于-5%，梗死周边节段定义为紧邻梗死节段。

结果

梗死区的纵向应变最差（-0.5%±3.0%），而梗死周边区和远隔区的纵向应变保持得更好（分别为-10.8%±1.9%和-14.5%±3.0%；方差分析，P＜.001）。72 例（54%）患者在 EP 研究中可诱发性单形性 VT。诱发性与非诱发性患者的 LV 射血分数（31%±9%比 32%±11%，P=0.29）无显著差异。诱发性患者的梗死周边区纵向收缩峰值应变更差（-9.8%±1.5%比-11.0%±2.1%，P=0.001），但梗死区（-0.5%±3.2%比-0.4%±2.7%，P=0.75）和远隔区（-14.6%±2.8%比-14.5%±3.4%，P=0.92）的 LPSS 无差异。多因素逻辑回归分析仅发现梗死周边区的 LPSS（OR 1.43，95%CI 1.15-1.78，P=0.001）与单形性 VT 的诱发性独立相关。