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斑点追踪超声心动图对前壁心肌梗死患者梗死面积的预测

Prediction of infarct size by speckle tracking echocardiography in patients with anterior myocardial infarction.

作者信息

Grabka Marek, Wita Krystian, Tabor Zbigniew, Paraniak-Gieszczyk Barbara, Chmurawa Jarosław, Elżbieciak Marek, Bochenek Tomasz, Doruchowska-Raczek Anika, Trusz-Gluza Maria

机构信息

1st Department of Cardiology, Silesian University of Medicine, Katowice, Poland.

出版信息

Coron Artery Dis. 2013 Mar;24(2):127-34. doi: 10.1097/MCA.0b013e32835b6798.

Abstract

BACKGROUND

Speckle tracking echocardiography (STE) is based on tracing of pixel groups in grayness scale for the quantitative measurement of myocardium strain and myocardium strain rate. Recent data suggest that evaluation of STE could be a tool for myocardial function assessment similar to MRI.

AIM

To assess the predictive value of STE for the evaluation of infarct size in patients with anterior ST-elevation myocardial infarction (STEMI).

MATERIALS AND METHODS

We enrolled 39 patients with the first anterior wall STEMI (mean age 59±10 years, 29 men). All patients were treated with a primary percutaneous coronary intervention, and the time from the symptom onset to reperfusion was 298±195 min. Left ventricular ejection fraction assessed in three-dimensional echocardiography was 47±9%. On the day of discharge, STE was performed to determine the average global value of peak longitudinal strain (GLS) of 16 myocardial segments. The average value of the peak longitudinal strain for nine segments supplied by the left anterior descending artery anterior wall global longitudinal strain was assessed separately. Infarct size was assessed 3 months after STEMI by MRI using late gadolinium enhancement, and a large infarct was defined as at least 20% left ventricle myocardium covered by the scar.

RESULTS

According to the results of MRI, we defined two groups: 22 patients with a large infarct (≥20%, group A) and 17 patients with a small infarct (<20%, group B). There were no differences between both groups in the demographics and cardiovascular risk factors. There was a significant correlation between GLS and the degree of myocardium injury assessed by MRI (r=0.62, P=0.001). The correlation was higher for anterior wall global longitudinal strain (r=0.68, P=0.001). With the receiver operating characteristic curve, the cut-off point for GLS was calculated (-12.3), which defined a large infarct with 82% sensitivity and 87% specificity (area under the curve=83). For segments supplied by the left anterior descending artery, the cut-off value for the prediction of a large infarct was -11.5 (sensitivity 90%, specificity 73%, area under the curve=84).

CONCLUSION

STE seems to be a very promising tool in the prediction of infarct size in patients with anterior STEMI.

摘要

背景

斑点追踪超声心动图(STE)基于对灰度图像中像素组的追踪,用于定量测量心肌应变和心肌应变率。近期数据表明,STE评估可能是一种类似于MRI的心肌功能评估工具。

目的

评估STE对前壁ST段抬高型心肌梗死(STEMI)患者梗死面积评估的预测价值。

材料与方法

我们纳入了39例首次发生前壁STEMI的患者(平均年龄59±10岁,男性29例)。所有患者均接受了直接经皮冠状动脉介入治疗,症状发作至再灌注时间为298±195分钟。三维超声心动图评估的左心室射血分数为47±9%。出院当天,进行STE以确定16个心肌节段的峰值纵向应变(GLS)的平均整体值。分别评估左前降支供应的9个节段的前壁整体纵向应变的峰值纵向应变平均值。STEMI后3个月通过MRI使用延迟钆增强评估梗死面积,大梗死定义为至少20%的左心室心肌被瘢痕覆盖。

结果

根据MRI结果,我们将患者分为两组:22例大梗死患者(≥20%,A组)和17例小梗死患者(<20%,B组)。两组在人口统计学和心血管危险因素方面无差异。GLS与MRI评估的心肌损伤程度之间存在显著相关性(r = 0.62,P = 0.001)。前壁整体纵向应变的相关性更高(r = 0.68,P = 0.001)。通过受试者工作特征曲线,计算出GLS的截断点(-12.3),其定义大梗死的灵敏度为82%,特异性为87%(曲线下面积 = 83)。对于左前降支供应的节段,预测大梗死的截断值为-11.5(灵敏度90%,特异性73%,曲线下面积 = 84)。

结论

STE似乎是预测前壁STEMI患者梗死面积的非常有前景的工具。

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