经皮冠状动脉介入治疗下壁心肌梗死患者右心室心肌速度的诊断和预后价值。

The diagnostic and prognostic value of right ventricular myocardial velocities in inferior myocardial infarction treated with primary percutaneous intervention.

机构信息

Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland.

出版信息

Kardiol Pol. 2011;69(10):1054-61.

PMID:22006608

Abstract

BACKGROUND

Right ventricular (RV) involvement increases mortality and morbidity in inferior myocardial infarction (MI). There are sparse data on the usefulness of pulsed tissue Doppler imaging (TDI) in the diagnosis of RV dysfunction in ST segment elevation MI (STEMI) treated by primary percutaneous coronary intervention (pPCI).

AIM

To evaluate the diagnostic and prognostic significance of RV myocardial velocities compared to classical electrocardiographic RVMI diagnostic criteria in this group of patients.

METHODS

Consecutive patients with first, acute, inferior STEMI treated with pPCI were prospectively assessed. The RVMI was defined as an ST-segment elevation ≥ 0.1 mV in lead V4R. Echocardiography with TDI was performed after pPCI within 24 h of the onset of symptoms. Follow up including in-hospital events was performed.

RESULTS

Out of 101 patients (58 males, mean age 63.7 ± 11.1 years), RVMI was found in 37 (37%). In multivariate analysis, peak systolic RV velocity (SmRV) (OR 5.12), peak early diastolic RV velocity (EmRV) (OR 5.03) and RV wall motion abnormalities (OR 4.94) were independent parameters for RVMI diagnosis. Receiver operating characteristics revealed high diagnostic significance of SmRV (C statistics = 0.90) and EmRV (C statistics = 0.89). The SmRV < 12 cm/s as a cut-off for a diagnosis of RVMI had a 89% sensitivity and a 83% specificity, whereas EmRV < 10 cm/s - 81% and 80%, respectively. Multivariate analysis showed that two variables - SmRV and ST-segment elevation ≥ 0.1 mV in lead V4R, were independent predictors of in-hospital prognosis.

CONCLUSIONS

Right ventricular myocardial velocities derived from TDI predict ECG diagnosis of RVMI with relatively high sensitivity and specificity. Their high negative predictive value may be of practical importance when ECG tracings are equivocal. More importantly, decreased RV systolic myocardial Doppler velocity predicts unfavourable clinical outcomes in patients with inferior STEMI independently of ECG changes.

摘要

背景

右心室（RV）受累会增加下壁心肌梗死（MI）的死亡率和发病率。在经皮冠状动脉介入治疗（pPCI）治疗的ST 段抬高型心肌梗死（STEMI）患者中，脉冲组织多普勒成像（TDI）在诊断 RV 功能障碍方面的有用性数据很少。

目的

评估与 RVMI 的经典心电图诊断标准相比，RV 心肌速度在该组患者中的诊断和预后意义。

方法

前瞻性评估连续接受 pPCI 治疗的首次急性下壁 STEMI 患者。RVMI 定义为 V4R 导联 ST 段抬高≥0.1 mV。在症状发作后 24 小时内进行 pPCI 后进行 TDI 超声心动图检查。进行包括住院期间事件的随访。

结果

101 例患者（58 例男性，平均年龄 63.7±11.1 岁）中发现 RVMI 37 例（37%）。多变量分析显示，收缩期峰值 RV 速度（SmRV）（OR 5.12）、舒张早期 RV 速度峰值（EmRV）（OR 5.03）和 RV 壁运动异常（OR 4.94）是 RVMI 诊断的独立参数。ROC 曲线显示 SmRV（C 统计=0.90）和 EmRV（C 统计=0.89）具有较高的诊断意义。SmRV<12cm/s 作为 RVMI 诊断的截断值，其敏感性为 89%，特异性为 83%，而 EmRV<10cm/s 的敏感性和特异性分别为 81%和 80%。多变量分析显示，SmRV 和 V4R 导联 ST 段抬高≥0.1 mV 两个变量是住院期间预后的独立预测因素。