Department of Cardiology, Rambam Healthcare Campus, Haifa, Israel; Technion-Israel Institute of Technology, Haifa, Israel.
J Am Soc Echocardiogr. 2013 Nov;26(11):1235-44. doi: 10.1016/j.echo.2013.07.008. Epub 2013 Aug 20.
Visual left ventricular (LV) wall motion scoring is well established for the assessment of LV function, yet it is subjective, circumstantial, and relative and requires long training. Quantification of myocardial shortening (strain) using two-dimensional speckle-tracking is potentially less subjective. In this study, quantifiable LV contraction (two-dimensional strain) was prospectively cross-related with wall motion score (WMS) and radionuclide myocardial perfusion imaging (MPI) score in 20 patients (mean age, 54 ± 9 years) with acute myocardial infarctions, early and late after percutaneous revascularization.
Echocardiography and rest MPI were performed 3 to 5 days after acute myocardial infarction. Echocardiography was repeated at 4 months. Peak segmental and global endocardial longitudinal strain (LS) and circumferential strain (CS) were measured, and principal strain was calculated. Volumes, WMS, MPI scores, and strain were assessed independently.
Two-dimensional strain, visual WMS, and radionuclide MPI score correlated closely. Strain thresholds for abnormal WMS were 11.7% for early LS, 18.2% for early CS, 13.9% for late LS, and 19.1% for late CS. Late principal strain correlated better with WMS and MPI score than either LS or CS. CS varied minimally over time, while LS improved in most segments. Higher early CS (>15%) was predictive of segmental functional recovery. MPI score correlated better with late rather than early strain, probably because early resting perfusion defects represent permanent damage.
In this pilot study, strain correlated with echocardiographic WMS and the extent of ischemia (MPI score) early and late after revascularization in patients with acute myocardial infarction. Longitudinal and circumferential strain uncoupling was observed. LS appeared to be more sensitive to acute ischemia, whereas CS correlated better with improvement after revascularization.
视觉左心室（LV）壁运动评分已广泛用于评估 LV 功能，但它具有主观性、偶然性和相对性，且需要长期培训。使用二维斑点追踪技术对心肌缩短（应变）进行定量分析可能主观性更小。在这项研究中，我们前瞻性地将可量化的 LV 收缩（二维应变）与 20 例急性心肌梗死后经皮血运重建早期和晚期的壁运动评分（WMS）和放射性核素心肌灌注成像（MPI）评分相关联，这些患者的平均年龄为 54±9 岁。
急性心肌梗死后 3 至 5 天行超声心动图和静息 MPI 检查，4 个月时重复行超声心动图检查。测量峰值节段和整体心内膜纵向应变（LS）和圆周应变（CS），并计算主应变。评估容积、WMS、MPI 评分和应变。
二维应变、视觉 WMS 和放射性核素 MPI 评分密切相关。WMS 异常的应变阈值为早期 LS 为 11.7%，早期 CS 为 18.2%，晚期 LS 为 13.9%，晚期 CS 为 19.1%。晚期主应变与 WMS 和 MPI 评分的相关性优于 LS 或 CS。CS 随时间变化极小，而 LS 在大多数节段均有改善。早期 CS 较高（>15%）预示节段功能恢复。MPI 评分与晚期应变的相关性优于早期应变，可能是因为早期静息灌注缺陷代表永久性损伤。
在这项初步研究中，应变与超声心动图 WMS 和急性心肌梗死后血运重建早期和晚期的缺血程度（MPI 评分）相关。观察到纵向和圆周应变解耦。LS 似乎对急性缺血更敏感，而 CS 与血运重建后改善的相关性更好。
