对于接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者，多普勒组织成像术是预后的独立预测指标。

Doppler tissue imaging is an independent predictor of outcome in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

作者信息

Biering-Sørensen Tor, Jensen Jan Skov, Pedersen Sune, Galatius Søren, Hoffmann Soren, Jensen Magnus Thorsten, Mogelvang Rasmus

机构信息

Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark; Institute of Clinical Medicine Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

出版信息

J Am Soc Echocardiogr. 2014 Mar;27(3):258-67. doi: 10.1016/j.echo.2013.11.005. Epub 2013 Dec 8.

DOI:10.1016/j.echo.2013.11.005

PMID:24325959

Abstract

BACKGROUND

Doppler tissue imaging (DTI) detects early signs of left ventricular (LV) dysfunction; however, the prognostic significance of DTI after ST-segment elevation myocardial infarction (STEMI) is unknown. The aim of this study was to evaluate the prognostic value of DTI after STEMI in patients treated with primary percutaneous coronary intervention.

METHOD

In total, 391 patients who were admitted with STEMIs and treated with primary percutaneous coronary intervention were prospectively included. All participants were examined by echocardiography 2 days (interquartile range, 1-3 days) after STEMI. Longitudinal systolic (s'), early diastolic (e'), and late diastolic (a') myocardial velocities were measured using color DTI at six mitral annular sites and averaged to provide global estimates.

RESULTS

The median follow-up period was 25 months (interquartile range, 19-32 months). The primary end point was a composite of death, heart failure, or a new myocardial infarction. Patients with low global systolic function (s') or low global diastolic function (e') had >2 times greater risk for the combined end point compared with patients with high global s' (hazard ratio, 2.60; 95% confidence interval, 1.64-4.13; P < .001) or e' (hazard ratio, 2.26; 95% confidence interval, 1.44-3.55; P < .001), respectively. After adjustment for age, gender, peak troponin I, previous myocardial infarction, LV ejection fraction, LV mass index, and LV dimension in a multivariate Cox model, patients with low values of both global s' and e' remained at significantly higher risk than patients with high s' and/or e' (hazard ratio, 1.69; 95% confidence interval, 1.02-2.81; P = .043).

CONCLUSIONS

A pattern of low systolic and diastolic performance as assessed by DTI is a paramount marker of adverse prognosis for patients with STEMIs independent of conventional echocardiographic parameters. DTI velocities should be evaluated together as they interact with the prognosis.

摘要

背景

多普勒组织成像（DTI）可检测出左心室（LV）功能障碍的早期迹象；然而，ST段抬高型心肌梗死（STEMI）后DTI的预后意义尚不清楚。本研究的目的是评估在接受直接经皮冠状动脉介入治疗的患者中，STEMI后DTI的预后价值。

方法

前瞻性纳入了总共391例因STEMI入院并接受直接经皮冠状动脉介入治疗的患者。所有参与者在STEMI后2天（四分位间距，1 - 3天）接受超声心动图检查。使用彩色DTI在六个二尖瓣环部位测量纵向收缩期（s'）、舒张早期（e'）和舒张晚期（a'）心肌速度，并进行平均以提供整体评估。

结果

中位随访期为25个月（四分位间距，19 - 32个月）。主要终点是死亡、心力衰竭或新发心肌梗死的复合终点。与整体s'较高的患者相比，整体收缩功能较低（s'）或整体舒张功能较低（e'）的患者发生联合终点的风险高2倍以上（风险比，2.60；95%置信区间，1.64 - 4.13；P <.001）或e'（风险比，2.26；95%置信区间，1.44 - 3.55；P <.001）。在多变量Cox模型中对年龄、性别、肌钙蛋白I峰值、既往心肌梗死、左心室射血分数、左心室质量指数和左心室尺寸进行调整后，整体s'和e'值均较低的患者仍然比s'和/或e'较高的患者具有显著更高的风险（风险比，1.69；95%置信区间，1.02 - 2.81；P =.043）。