Haberka Maciej, Liszka Jerzy, Kozyra Andrzej, Finik Maciej, Gąsior Zbigniew
2nd Department of Cardiology, Medical University of Silesia, Katowice, Poland.
Echocardiography. 2015 Mar;32(3):454-60. doi: 10.1111/echo.12666. Epub 2014 Jun 28.
The aim of the study was to evaluate the left ventricle (LV) function with speckle tracking echocardiography (STE) and to assess its relation to prognosis in patients after acute myocardial infarction (AMI).
Sixty-three patients (F/M = 16/47 pts; 62.33 ± 11.85 years old) with AMI (NSTEMI/STEMI 24/39 pts) and successful percutaneous coronary intervention (PCI) with stent implantation (thrombolysis in myocardial infarction; TIMI 3 flow) were enrolled in this study. All patients underwent baseline two-dimensional conventional echocardiography and STE 3 days (baseline) and 30 days after PCI. All patients were followed up for cardiovascular clinical endpoints, major adverse cardiovascular endpoint (MACE), and functional status (Canadian Cardiovascular Society and New York Heart Association).
During the follow-up (31.9 ± 5.1 months), there were 3 cardiovascular deaths, 15 patients had AMI, 2 patients had cerebral infarction, 24 patients reached the MACE. Baseline LV torsion (P = 0.035), but none of the other strain parameters were associated with the time to first unplanned cardiovascular hospitalization. Univariate analysis showed that baseline longitudinal two-chamber and four-chamber strain (sLa2 0 and sLa4 0) and the same parameters obtained 30 days after the AMI together with transverse four-chamber strain (sLa2 30, sLa4 30, and sTa4 30) were significantly associated with combined endpoint (MACE). The strongest association in the univariate analysis was found for the baseline sLa2. However, in multivariable analysis only a left ventricular remodeling (LVR - 27% pts) was significantly associated with MACE and strain parameters were not associated with the combined endpoint.
The assessment of LV function with STE may improve cardiovascular risk prediction in postmyocardial infarction patients.
本研究旨在采用斑点追踪超声心动图（STE）评估左心室（LV）功能，并评估其与急性心肌梗死（AMI）患者预后的关系。
本研究纳入了63例AMI患者（女性/男性=16/47例；年龄62.33±11.85岁），其中非ST段抬高型心肌梗死/ST段抬高型心肌梗死24/39例，均成功接受了经皮冠状动脉介入治疗（PCI）并植入支架（心肌梗死溶栓治疗；TIMI 3级血流）。所有患者在PCI术后3天（基线）和30天接受了二维常规超声心动图和STE检查。所有患者均随访心血管临床终点、主要不良心血管终点（MACE）和功能状态（加拿大心血管学会和纽约心脏协会）。
在随访期间（31.9±5.1个月），有3例心血管死亡，15例患者发生AMI，2例患者发生脑梗死，24例患者达到MACE。基线左心室扭转（P=0.035），但其他应变参数均与首次非计划心血管住院时间无关。单因素分析显示，基线纵向双腔和四腔应变（sLa2 0和sLa4 0）以及AMI后30天获得的相同参数与横向四腔应变（sLa2 30、sLa4 30和sTa4 30）一起与联合终点（MACE）显著相关。单因素分析中最强的关联是基线sLa2。然而，在多变量分析中，只有左心室重构（LVR-27%患者）与MACE显著相关，应变参数与联合终点无关。
采用STE评估LV功能可能改善心肌梗死后患者的心血管风险预测。
