Institute of Cardiovascular Disease, Xuzhou Medical College, 84 West Huaihai Road, Xuzhou 221002, China.
Int J Cardiovasc Imaging. 2013 Jun;29(5):1017-28. doi: 10.1007/s10554-013-0185-y. Epub 2013 Jan 29.
It is clinically important to determine the myocardial viability of regional wall motion abnormality segments in patients with acute myocardial infarction (AMI). The purpose of this study was to ascertain the ability and value of a combination of speckle tracking echocardiography (STE) and low dose dobutamine stress echocardiography (LDDSE) for the evaluation of viable myocardium in patients with AMI. Forty-two hospitalized patients with AMI and left ventricular systolic dysfunction (left ventricular ejection fraction <50%) were underwent STE in conjunction with LDDSE and dual isotope simultaneous acquisition single photon emission computed tomography (DISA-SPECT). Percutaneous coronary intervention (PCI) was performed subsequently in all patients. STE was used to measure radial, circumferential, and longitudinal end-systolic strain and peak systolic strain rate. The movement of each segment was observed by routine echocardiography 1, 3, and 6 months after PCI, and its improvement over time was the criterion of viable myocardium. The sensitivity, specificity and accuracy of DISA-SPECT for the assessment of viable myocardium were 83.6, 74.4, and 80.7%, respectively. Among the radial, circumferential, and longitudinal strain and strain rate parameters, only longitudinal strain (LS) and longitudinal strain rate (LSr) at rest and LDDSE emerged as independent predictors of viable myocardium, When combining LS and LSr at LDDSE, the sensitivity, specificity and accuracy for the assessment of viable myocardium rose to 89.8, 90.2 and 89.9%, respectively. The sensitivity of STE in conjunction with LDDSE was similar to DISA-SPECT for detecting viable myocardium in patients with AMI, but the specificity and accuracy of STE performed with LDDSE were higher than DISA-SPECT.
在急性心肌梗死（AMI）患者中，确定局部室壁运动异常节段的心肌活力具有重要的临床意义。本研究旨在确定斑点追踪超声心动图（STE）和小剂量多巴酚丁胺负荷超声心动图（LDDSE）联合应用于评估 AMI 患者存活心肌的能力和价值。42 例 AMI 合并左心室收缩功能障碍（左心室射血分数<50%）的住院患者同时进行 STE 和 LDDSE 以及双同位素同时采集单光子发射计算机断层扫描（DISA-SPECT）检查。所有患者随后均进行经皮冠状动脉介入治疗（PCI）。STE 用于测量径向、周向和纵向收缩末期应变和收缩期峰值应变率。PCI 后 1、3 和 6 个月常规超声心动图观察各节段运动情况，节段运动改善程度为存活心肌的标准。DISA-SPECT 评估存活心肌的敏感性、特异性和准确性分别为 83.6%、74.4%和 80.7%。在径向、周向和纵向应变和应变率参数中，仅静息时的纵向应变（LS）和纵向应变率（LSr）以及 LDDSE 时的 LS 和 LSr 是存活心肌的独立预测因子。当将 LDDSE 时的 LS 和 LSr 相结合时，评估存活心肌的敏感性、特异性和准确性分别提高至 89.8%、90.2%和 89.9%。STE 联合 LDDSE 检测 AMI 患者存活心肌的敏感性与 DISA-SPECT 相似，但 LDDSE 检测 STE 的特异性和准确性高于 DISA-SPECT。
