Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
Int J Cardiovasc Imaging. 2013 Feb;29(2):275-84. doi: 10.1007/s10554-012-0085-6. Epub 2012 Jun 27.
To evaluate 2-dimensional speckle tracking echocardiography as a diagnostic and prognostic tool in patients with acute myocarditis. In this retrospective cohort study, 45 patients (age, 39 ± 15 years; 32 male) with suspected acute myocarditis and 83 healthy controls (age, 39 ± 13 years; 27 male) underwent 2-dimensional speckle tracking echocardiography. Main outcome measures were circumferential and longitudinal strain and strain rate as prognostic and diagnostic markers. Patients with myocarditis had lower circumferential strain (-13.3 ± 5.6 % vs. -22.3 ± 4 %), circumferential strain rate (-0.9 ± 0.3 vs. -1.4 ± 0.3 s(-1)), longitudinal strain (-11.7 ± 4 % vs. -17.7 ± 1.9 %), and longitudinal strain rate (-0.7 ± 0.2 vs. -1.0 ± 0.1 s(-1)) (all P < .001). For diagnostic purposes, longitudinal strain had the greatest area under the curve, 0.93 (optimal cutoff value, -15.1 %; sensitivity, 78 %; specificity, 93 %). Future events were defined as cardiac death, heart transplant, placement of left ventricular assist device or implantable cardioverter-defibrillator, pulmonary edema-related respiratory failure, cardiogenic shock, and rehospitalization due to cardiac events. For every 1 % decline in longitudinal or circumferential strain, the hazard ratios (95 % CIs) were 1.26 (1.10-1.47) and 1.34 (1.14-1.63), respectively; for every 0.1 s(-1) decline in longitudinal or circumferential strain rate, the hazard ratios (95 % CIs) were 1.43 (1.09-1.89) and 1.52 (1.19-2.01), respectively (P < .01). Kaplan-Meier curve and log-rank test showed event-free survival significantly related to these 4 measurements. In acute myocarditis, left ventricular strain and strain rate may be promising diagnostic and prognostic tools, even in patients with preserved left ventricular ejection fraction. Most importantly, this imaging technique had a role in predicting deterioration and overall event-free survival.
评估二维斑点追踪超声心动图在急性心肌炎患者中的诊断和预后价值。本回顾性队列研究纳入 45 例疑似急性心肌炎患者（年龄 39 ± 15 岁，32 例男性）和 83 例健康对照者（年龄 39 ± 13 岁，27 例男性），所有患者均行二维斑点追踪超声心动图检查。主要终点指标为圆周应变和纵向应变及应变率作为预测和诊断标志物。心肌炎患者的圆周应变（-13.3 ± 5.6% vs. -22.3 ± 4%）、圆周应变率（-0.9 ± 0.3 vs. -1.4 ± 0.3 s(-1)）、纵向应变（-11.7 ± 4% vs. -17.7 ± 1.9%）和纵向应变率（-0.7 ± 0.2 vs. -1.0 ± 0.1 s(-1)）均降低（均 P <.001）。对于诊断目的，纵向应变的曲线下面积最大，为 0.93（最佳截断值为-15.1%；敏感性为 78%；特异性为 93%）。未来事件定义为心脏性死亡、心脏移植、左心室辅助装置或植入式心脏除颤器的植入、与肺水肿相关的呼吸衰竭、心源性休克和因心脏事件再次住院。纵向应变或圆周应变每下降 1%，风险比（95%CI）分别为 1.26（1.10-1.47）和 1.34（1.14-1.63）；纵向应变或圆周应变率每下降 0.1 s(-1)，风险比（95%CI）分别为 1.43（1.09-1.89）和 1.52（1.19-2.01）（均 P <.01）。Kaplan-Meier 曲线和对数秩检验显示无事件生存与这 4 项测量明显相关。在急性心肌炎中，左心室应变和应变率可能是很有前途的诊断和预后工具，即使在左心室射血分数保留的患者中也是如此。最重要的是，该影像学技术在预测病情恶化和整体无事件生存方面具有重要作用。
