二维斑点追踪超声心动图评估心肌梗死及直接再灌注治疗后患者的左心室重构
Two-dimensional speckle-tracking echocardiography assessment of left ventricular remodeling in patients after myocardial infarction and primary reperfusion.
作者信息
Liszka Jerzy, Haberka Maciej, Tabor Zbigniew, Finik Maciej, Gąsior Zbigniew
机构信息
Department of Cardiology, Multidisciplinary Hospital, Jaworzno, Poland.
School of Health Sciences, Medical University of Silesia, Department of Cardiology, Katowice, Poland.
出版信息
Arch Med Sci. 2014 Dec 22;10(6):1091-100. doi: 10.5114/aoms.2014.47821.
INTRODUCTION
Left ventricular remodeling (LVR) is the most prognostically important consequence of acute myocardial infarction (AMI). The aim of the study was to assess the value of speckle tracking echocardiography in the prediction of left ventricular remodeling in patients after AMI and primary coronary angioplasty (PCI).
MATERIAL AND METHODS
Eighty-eight patients (F/M = 31/57 patients; 63.6 ±11 years old) with coronary artery disease (CAD) and successful PCI were enrolled and divided into group I with ST-elevation myocardial infarction or non-ST elevation myocardial infarction and group II with stable angina pectoris. Conventional and speckle tracking echocardiography was performed 3 days (baseline), 30 days and 90 days after PCI. Patients were divided into 2 groups based on the presence of LVR (increase of LV end-diastolic and/or end-systolic volume > 20%) at 3 months follow-up.
RESULTS
At initial presentation, 2-chamber longitudinal strain (9.4 ±3.5% vs. -11.6 ±3.6%, p < 0.04) and 4-chamber transverse strain (10.4 ±8.2% vs. 15.6 ±8%, p < 0.003) were lower in the LVR+ group compared to the LVR- group. LV wall motion score index did not differ between the two groups. After 30 days, circumferential apical and basal strain (-15.58 ±8.9% vs. -25.53 ±8.8%, p < 0.001; -15.02 ±5.6 vs. -19.78 ±6.3, p < 0.008), radial apical strain (9.96 ±8.4% vs. 14.15 ±5.5%, p < 0.03), 4-chamber longitudinal strain (-8.7 ±5.8% vs. -13.47 ±3.9%, p < 0.005), 4-chamber transverse strain (10.5 ±8.1% vs. 16.7 ±8.3%, p < 0.03), apical rotation (3.84 ±2.5° vs, 5.66 ±3.2°, p < 0.04) and torsion (6.15 ±4.1° vs. 8.98 ±4.6°, p < 0.03) were significantly decreased in the LVR+ group compared to the LVR- group. According to ROC analysis, circumferential apical strain > -15.92% (sensitivity 93%, specificity 59%, positive predictive value 90%) was the most powerful predictor of remodeling after primary PCI in AMI.
CONCLUSIONS
Our results suggest that impaired indices of LV deformation detected 3 days and 30 days after AMI may provide important predictive value in LV remodeling and patients' follow-up.
引言
左心室重构（LVR）是急性心肌梗死（AMI）最重要的预后相关后果。本研究旨在评估斑点追踪超声心动图在预测AMI后接受直接冠状动脉血管成形术（PCI）患者左心室重构中的价值。
材料与方法
纳入88例冠状动脉疾病（CAD）且PCI成功的患者（女性/男性 = 31/57例；年龄63.6±11岁），分为I组（ST段抬高型心肌梗死或非ST段抬高型心肌梗死）和II组（稳定型心绞痛）。在PCI术后3天（基线）、30天和90天进行常规及斑点追踪超声心动图检查。根据3个月随访时是否存在LVR（左心室舒张末期和/或收缩末期容积增加>20%）将患者分为两组。
结果
初次检查时，LVR+组的两腔室纵向应变（9.4±3.5%对-11.6±3.6%，p<0.04）和四腔室横向应变（10.4±8.2%对15.6±8%，p<0.003）低于LVR-组。两组间左心室壁运动评分指数无差异。30天后，LVR+组的圆周方向心尖和心底应变（-15.58±8.9%对-25.53±8.8%，p<0.001；-15.02±5.6对-19.78±6.3，p<0.008）、径向心尖应变（9.96±8.4%对14.15±5.5%，p<0.03）、四腔室纵向应变（-8.7±5.8%对-13.47±3.9%，p<0.005）、四腔室横向应变（10.5±8.1%对16.7±8.3%，p<0.03）、心尖旋转（3.84±2.5°对5.66±3.2°，p<0.04）和扭转（6.15±4.1°对8.98±4.6°，p<0.03）均显著低于LVR-组。根据ROC分析，圆周方向心尖应变>-15.92%（敏感性93%，特异性59%，阳性预测值90%）是AMI直接PCI后重构的最有力预测指标。
结论
我们的结果表明，AMI后3天和30天检测到的左心室变形指标受损可能对左心室重构及患者随访具有重要预测价值。
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