Ran Hong, Zhang Ping-yang, Fang Ling-ling, Ma Xiao-wu, Wu Wen-fang, Feng Wang-fei
Department of Echocardiography, Nanjing Medical University, Nanjing, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2013 Jan;41(1):28-32.
Regional left ventricular (LV) function could be detected by measuring peak-systolic strain by speckle tracking imaging (STI). We evaluated the value of STI combined with adenosine stress echocardiography on assessing myocardial viability in patients with myocardial infarction (MI).
Two dimensional echocardiography was performed at rest and after adenosine stress echocardiography (infused at 140 µg×kg(-1)×min(-1) over a period of 6 min) in 39 stable patients with previous MI. Peak-systolic (Speak-sys) circumferential strain, radial strain and longitudinal strain were assessed by STI. Radionuclide myocardial perfusion/metabolic imaging served as the "gold standard" to detection of myocardial viability.
(1) There were 215 viable and 153 non-viable regions among 368 abnormal motion segments out of 624 segments in 39 MI patients according to radionuclide imaging results. (2) Speak-sys was similar between viable and nonviable myocardium at rest (all P > 0.05). After adenosine infusion, radial Speak-sys [(37.98 ± 5.45)% vs. (30.22 ± 5.47)%], longitudinal Speak-sys [(-23.71 ± 4.53)% vs. (-17.52 ± 4.34)%] increased significantly (P < 0.05)in viable segments compared to baseline levels and were significantly higher than in nonviable segments radial Speak-sys [(37.98 ± 5.45)% vs. (30.12 ± 5.37)%] and longitudinal Speak-sys [(-23.71 ± 4.53)% vs. (-16.95 ± 4.62)%] (P < 0.05), while remained unchanged in nonviable segments before and after adenosine infusion. Circumferential Speak-sys was similar before and after adenosine infusion in both viable and nonviable segments (all P > 0.05). (3) Delta radial strain change > 9.8% has a sensitivity of 82.3% and a specificity of 81.1% whereas a delta change of longitudinal strain > 16.5% has a sensitivity of 83.5% and a specificity of 92.3% for detecting viable segments.
Speckle tracking imaging combined with adenosine stress echocardiography could serve as a new and reliable method of assessing myocardial viability.
通过斑点追踪成像（STI）测量峰值收缩期应变来检测局部左心室（LV）功能。我们评估了STI联合腺苷负荷超声心动图在评估心肌梗死（MI）患者心肌存活性方面的价值。
对39例既往有MI的稳定患者在静息状态下及腺苷负荷超声心动图检查后（以140μg×kg⁻¹×min⁻¹的速度输注6分钟）进行二维超声心动图检查。通过STI评估峰值收缩期（Speak-sys）圆周应变、径向应变和纵向应变。放射性核素心肌灌注/代谢成像作为检测心肌存活性的“金标准”。
（1）根据放射性核素成像结果，39例MI患者的624个节段中有368个运动异常节段，其中有215个存活节段和153个非存活节段。（2）静息时存活心肌和非存活心肌的Speak-sys相似（所有P>0.05）。腺苷输注后，存活节段的径向Speak-sys[（37.98±5.45）%对（30.22±5.47）%]、纵向Speak-sys[（-23.71±4.53）%对（-17.52±4.34）%]较基线水平显著增加（P<0.05），且显著高于非存活节段的径向Speak-sys[（37.98±5.45）%对（30.12±5.37）%]和纵向Speak-sys[（-23.71±4.53）%对（-16.95±4.62）%]（P<0.05），而非存活节段在腺苷输注前后保持不变。存活节段和非存活节段在腺苷输注前后圆周Speak-sys相似（所有P>0.05）。（3）对于检测存活节段，径向应变变化>9.8%时敏感性为82.3%，特异性为81.1%；纵向应变变化>16.5%时敏感性为83.5%，特异性为92.3%。
斑点追踪成像联合腺苷负荷超声心动图可作为评估心肌存活性的一种新的可靠方法。
