Kylmälä Minna M, Antila Margareta, Kivistö Sari M, Lauerma Kirsi, Toivonen Lauri, Laine Mika K
Division of Cardiology, Helsinki University Central Hospital, Haartmaninkatu 4, P.O.Box 340, 00029 HUS, Helsinki, Finland.
Eur J Echocardiogr. 2011 May;12(5):364-71. doi: 10.1093/ejechocard/jer026. Epub 2011 Mar 15.
To assess whether strain rate imaging (SRI) can serve to evaluate myocardial viability in patients with acute coronary syndrome (ACS).
In 23 patients with ACS, we measured longitudinal tissue Doppler strain and strain rate values from left ventricular basal, mid, and apical segments (n = 414). These segments were grouped according to their acute end-systolic strain values (S(ES)) into those with normocontraction (S(ES)≤-13%), hypocontraction (S(ES) between -13 and -7%), and severe contraction abnormality (S(ES)>-7%). At 8 months, we evaluated the recovery of contraction: Segments with acutely severe contraction abnormality that improved their strain values to ≤-7% were defined as viable, and those that failed to do so as non-viable. In the acute phase, S(ES), post-systolic strain, as well as systolic, early, and late diastolic strain rate values were significantly better in the viable than in the non-viable segments. Post-systolic strain had the best AUC 0.78, and a cut-off value of -3.8% predicted recovery from severe contraction abnormality with a sensitivity of 85% and specificity of 62%. The transmurality of the infarction, assessed by magnetic resonance imaging with delayed enhancement, was significantly larger in the non-viable than in the viable segments (P = 0.006). Acute global S(ES) and systolic strain rate showed the best correlations with final global S(ES) and global infarction percentage after recovery.
SRI can serve to evaluate myocardial viability in patients with ACS, and to assess the recovery of segmental as well as global left ventricular function.
评估应变率成像（SRI）是否可用于评估急性冠状动脉综合征（ACS）患者的心肌活力。
对23例ACS患者，我们测量了左心室基底段、中间段和心尖段（n = 414）的纵向组织多普勒应变及应变率值。这些节段根据其急性收缩末期应变值（S(ES)）分为正常收缩（S(ES)≤-13%）、收缩减弱（S(ES)在-13%至-7%之间）和严重收缩异常（S(ES)>-7%）三组。在8个月时，我们评估收缩功能的恢复情况：急性严重收缩异常节段其应变值改善至≤-7%的定义为存活节段，未改善的为非存活节段。在急性期，存活节段的S(ES)、收缩后应变以及收缩期、舒张早期和舒张晚期应变率值显著优于非存活节段。收缩后应变的曲线下面积（AUC）最佳，为0.78，截断值为-3.8%时预测严重收缩异常恢复的敏感性为85%，特异性为62%。通过磁共振成像延迟强化评估的梗死透壁程度，非存活节段显著大于存活节段（P = 0.006）。急性整体S(ES)和收缩期应变率与恢复后的最终整体S(ES)和整体梗死百分比显示出最佳相关性。
SRI可用于评估ACS患者的心肌活力，并评估节段性以及整体左心室功能的恢复情况。
