Service de Réanimation Médicale, Hôpital Central, Centre Hospitalier Universitaire de Nancy, Nancy, France.
Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, Centre Hospitalier Universitaire de Nancy, Vandoeuvre-lès-Nancy, France.
J Am Soc Echocardiogr. 2015 Jul;28(7):818-27.e4. doi: 10.1016/j.echo.2015.02.019. Epub 2015 Mar 31.
Right ventricular (RV) dysfunction after acute myocardial infarction (AMI) is frequent and associated with poor prognosis. The complex anatomy of the right ventricle makes its echocardiographic assessment challenging. Quantification of RV deformation by speckle-tracking echocardiography is a widely available and reproducible technique that readily provides an integrated analysis of all segments of the right ventricle. The aim of this study was to investigate the accuracy of conventional echocardiographic parameters and speckle-tracking echocardiographic strain parameters in assessing RV function after AMI, in comparison with cardiac magnetic resonance imaging (CMR).
A total of 135 patients admitted for AMI (73 anterior, 62 inferior) were prospectively studied. Right ventricular function was assessed by echocardiography and CMR within 2 to 4 days of hospital admission. Right ventricular dysfunction was defined as CMR RV ejection fraction < 50%. Right ventricular global peak longitudinal systolic strain (GLPSS) was calculated by averaging the strain values of the septal, lateral, and inferior walls.
Right ventricular dysfunction was documented in 20 patients. Right ventricular GLPSS was the best echographic correlate of CMR RV ejection fraction (r = -0.459, P < .0001) and possessed good diagnostic value for RV dysfunction (area under the receiver operating characteristic curve [AUROC], 0.724; 95% CI, 0.590-0.857), which was comparable with that of RV fractional area change (AUROC, 0.756; 95% CI, 0.647-0.866). In patients with inferior myocardial infarctions, the AUROCs for RV GLPSS (0.822) and inferolateral strain (0.877) were greater than that observed for RV fractional area change (0.760) Other conventional echocardiographic parameters performed poorly (all AUROCs < 0.700).
After AMI, RV GLPSS is the best correlate of CMR RV ejection fraction. In patients with inferior AMIs, RV GLPSS displays even higher diagnostic value than conventional echocardiographic parameters.
急性心肌梗死（AMI）后右心室（RV）功能障碍很常见，且与预后不良相关。RV 的复杂解剖结构使其超声心动图评估具有挑战性。斑点追踪超声心动图对 RV 变形的定量是一种广泛应用且可重复的技术，可轻松对 RV 的所有节段进行综合分析。本研究旨在探讨常规超声心动图参数和斑点追踪超声心动图应变参数在评估 AMI 后 RV 功能方面的准确性，并与心脏磁共振成像（CMR）进行比较。
前瞻性研究了 135 例因 AMI 入院的患者（前壁 73 例，下壁 62 例）。在入院后 2 至 4 天内通过超声心动图和 CMR 评估 RV 功能。RV 功能障碍定义为 CMR RV 射血分数<50%。通过计算间隔壁、侧壁和下壁的应变值来计算 RV 整体峰值纵向收缩应变（GLPSS）。
20 例患者存在 RV 功能障碍。RV GLPSS 与 CMR RV 射血分数相关性最好（r=-0.459，P<.0001），对 RV 功能障碍具有良好的诊断价值（ROC 曲线下面积[AUROC]，0.724；95%CI，0.590-0.857），与 RV 节段面积变化（AUROC，0.756；95%CI，0.647-0.866）相当。在下壁心肌梗死患者中，RV GLPSS（0.822）和下外侧应变（0.877）的 AUROC 大于 RV 节段面积变化（0.760），其他常规超声心动图参数的 AUROC 均<0.700。
在 AMI 后，RV GLPSS 是与 CMR RV 射血分数相关性最好的参数。在下壁 AMI 患者中，RV GLPSS 的诊断价值甚至高于常规超声心动图参数。
