二维斑点追踪应变成像评估 ST 段抬高型急性心肌梗死患者左心房容积和功能的变化及其作用

Comprehensive assessment of changes in left atrial volumes and function after ST-segment elevation acute myocardial infarction: role of two-dimensional speckle-tracking strain imaging.

机构信息

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

出版信息

J Am Soc Echocardiogr. 2011 Oct;24(10):1126-33. doi: 10.1016/j.echo.2011.06.017. Epub 2011 Aug 6.

DOI:10.1016/j.echo.2011.06.017

PMID:21820865

Abstract

BACKGROUND

Left atrial (LA) size has been associated with adverse outcome in patients after acute myocardial infarction. However, data about the occurrence of late LA enlargement and changes in LA function during follow-up are scarce. The purpose of the current study was to evaluate changes in LA size and function during 1-year follow-up.

METHODS

The study population comprised 407 patients with acute myocardial infarction who were treated with primary percutaneous coronary intervention. At baseline and 12 months, two-dimensional echocardiography was performed to assess LA volumes and function using speckle-tracking strain and strain rate.

RESULTS

The mean age was 60 ± 11 years, and most patients were men (78%). LA maximal volume increased from 25 ± 8 to 28 ± 8 mL/m(2) (P < .001) from baseline to 1 year. Echocardiographic assessment at 1-year follow-up showed that 92 patients (25%) had developed LA remodeling (defined as an increase of ≥8 mL/m(2) in LA maximal volume). On multivariate analysis, only LA maximal volume at baseline (odds ratio, 0.95; 95% confidence interval, 0.91-0.98; P = .003) and LA strain at baseline (odds ratio, 0.94; 95% confidence interval, 0.92-0.97; P < .001) were independent predictors of LA remodeling during follow-up. Interestingly in patients without LA remodeling, no changes were observed in LA function during follow-up. However, in patients with LA remodeling, LA function significantly worsened during follow-up. In line, LA strain and strain rate were significantly lower at 12 months compared with baseline (24 ± 7% vs 27 ± 6%, P < .001, and 1.8 ± 0.5 vs 2.4 ± 0.7 sec(-1), P < .001, respectively).

CONCLUSIONS

LA remodeling occurred in 22% of patients after acute myocardial infarction. In patients without LA remodeling, no changes in LA function were observed, but in patients with LA remodeling, LA function deteriorated significantly.

摘要

背景

左心房（LA）大小与急性心肌梗死后患者的不良预后相关。然而，关于在随访过程中晚期 LA 扩大和 LA 功能变化的数据很少。本研究的目的是评估 1 年随访期间 LA 大小和功能的变化。

方法

研究人群包括 407 名接受经皮冠状动脉介入治疗的急性心肌梗死患者。在基线和 12 个月时，使用斑点追踪应变和应变率进行二维超声心动图检查，以评估 LA 容积和功能。

结果

平均年龄为 60±11 岁，大多数患者为男性（78%）。LA 最大容积从基线时的 25±8 增加到 1 年后的 28±8 mL/m²（P<0.001）。在 1 年随访的超声心动图评估中，92 名患者（25%）出现 LA 重构（定义为 LA 最大容积增加≥8 mL/m²）。多变量分析显示，只有基线时的 LA 最大容积（比值比，0.95；95%置信区间，0.91-0.98；P=0.003）和基线时的 LA 应变（比值比，0.94；95%置信区间，0.92-0.97；P<0.001）是随访期间 LA 重构的独立预测因素。有趣的是，在没有 LA 重构的患者中，随访期间 LA 功能没有变化。然而，在 LA 重构的患者中，LA 功能在随访期间显著恶化。相应地，LA 应变和应变率在 12 个月时与基线相比显著降低（24±7%比 27±6%，P<0.001，1.8±0.5 比 2.4±0.7 sec(-1)，P<0.001）。