Division of Cardiology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
Am J Cardiol. 2011 Aug 1;108(3):340-7. doi: 10.1016/j.amjcard.2011.03.052. Epub 2011 May 19.
The aim of this study was to determine whether assessment of global longitudinal strain (GLS) before revascularization could predict adverse cardiac events after ST-segment elevation myocardial infarction (STEMI). In addition, the relation between GLS and cardiac biomarkers was investigated. From July 2006 through December 2009, 98 patients with first STEMI underwent conventional and speckle tracking echocardiography at initial presentation and 3 days after primary coronary intervention. Patients were divided into 3 groups according to percent changes of GLS compared to baseline GLS values: group 1, improved GLS >10%; group 2, unchanged GLS from -10% to 10%; and group 3, decreased GLS <-10%. Subsequent complications including all-cause mortality and readmission because of congestive heart failure during a 6-month period of follow-up were prospectively evaluated. After coronary intervention, GLS was improved in 29 patients (30%, group 1), unchanged in 55 patients (56%, group 2), and worsened in 14 patients (14%, group 3). Complications developed in 7 patients (group 1, n = 0, 0%; group 2, n = 2, 28%; group 3, n = 5, 72%, p <0.01). Multivariate Cox analysis showed an independent association of GLS before and after coronary intervention with subsequent complications. Significant correlations were observed between GLS and cardiac biomarkers. In conclusion, GLS assessment before coronary intervention was a good predictor of complications in patients with STEMI comparable to predictions using GLS after intervention at 6-month follow-up.
本研究旨在确定血运重建前整体纵向应变（GLS）评估是否可以预测 ST 段抬高型心肌梗死（STEMI）后的不良心脏事件。此外，还研究了 GLS 与心脏生物标志物之间的关系。
2006 年 7 月至 2009 年 12 月，98 例首次发生 STEMI 的患者在初次经皮冠状动脉介入治疗时和 3 天后进行常规和斑点追踪超声心动图检查。根据与基线 GLS 值相比 GLS 的百分比变化，将患者分为 3 组：组 1，改善 GLS>10%；组 2，GLS 从-10%至 10%不变；组 3，GLS 降低<-10%。前瞻性评估 6 个月随访期间的后续并发症，包括全因死亡率和因充血性心力衰竭再次入院。
经冠状动脉介入治疗后，29 例患者（30%，组 1）GLS 改善，55 例患者（56%，组 2）GLS 不变，14 例患者（14%，组 3）GLS 恶化。7 例患者出现并发症（组 1，0 例，0%；组 2，2 例，28%；组 3，5 例，72%，p<0.01）。多变量 Cox 分析显示，冠状动脉介入治疗前后的 GLS 与随后的并发症有独立关联。GLS 与心脏生物标志物之间存在显著相关性。
总之，冠状动脉介入治疗前的 GLS 评估是预测 STEMI 患者并发症的良好指标，与 6 个月随访时介入治疗后使用 GLS 预测相当。
