Huttin Olivier, Zhang Lin, Lemarié Jérémie, Mandry Damien, Juillière Yves, Lemoine Simon, Micard Emilien, Marie Pierre-Yves, Sadoul Nicolas, Girerd Nicolas, Selton-Suty Christine
Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, University Hospital of Nancy-Brabois, 54511, Vandoeuvre les Nancy, France.
Centre d'Investigation Clinique IADI U947, Nancy, France.
Int J Cardiovasc Imaging. 2015 Oct;31(7):1337-46. doi: 10.1007/s10554-015-0690-2. Epub 2015 Jun 5.
Microvascular obstruction (MVO) and transmural infarct size are prognostic factors after acute myocardial infarction (AMI). We assessed the value of myocardial deformation patterns using 3D speckle tracking imaging (3DSTI) in detecting myocardial and microvascular damage after AMI. One hundred patients with first ST-segment elevation MI from the REMI Study were prospectively included. Transthoracic echocardiography with 3DSTI and CMR were performed within 72 h after revascularization therapy. Global (3DG) and segmental (3DS) values of LV longitudinal (LS), circumferential and radial area strain were obtained. Late gadolinium enhancement (LGE) and MVO was quantified as transmural (>50%) or non-transmural (<50%). Predictive performance was assessed by area under the receiver operating curve characteristic (AUC). Mean LVEFCMR was 45.8 ± 9.2 % with 22.2 ± 12.7% transmural LGE. MVO was present in 55 patients (MVO transmural extent 11.4 ± 11.8%). In global analysis, all 3DG strain values were correlated with LVEFCMR and infarct size, with the best correlation obtained for 3DGAS (r = -0.678; p < 0.0001). All 3DG strain values, with the exception of LS, were significantly different between patients with and without MVO. In segmental analysis, all 3DS strain values were significantly lower in transmurally infarcted segments than in non-infarcted segments, and all 3DS values except 3DSRS were significantly lower in non-transmural infarcted segments than in non-infarcted segments. The best 3DS strain for detecting non-viable segments with MVO (MVO > 75%) was 3DSAS [AUC 0.867 (0.849-0.884), 78.0% sensitivity and 81.1% specificity for 3DSAS = -16.1%]. Importantly, 3DSRS and 3DSAS were associated with an increase in diagnostic accuracy of both transmural LGE and MVO over 3DSLS (all increase in AUC > 0.04, all p < 0.01). The newly developed 3DSTI, especially 3DSAS, is a sensitive and reproducible tool to predict and quantify the transmural extent of scar. This new early imaging strategy improve the prediction of MVO while enabling to assess the success of reperfusion and the risk of late systolic remodeling in STEMI.
微血管阻塞（MVO）和透壁梗死面积是急性心肌梗死（AMI）后的预后因素。我们评估了使用三维斑点追踪成像（3DSTI）的心肌变形模式在检测AMI后心肌和微血管损伤方面的价值。前瞻性纳入了100例来自REMI研究的首次ST段抬高型心肌梗死患者。在血运重建治疗后72小时内进行经胸超声心动图检查及3DSTI和心脏磁共振成像（CMR）检查。获得左心室纵向（LS）、圆周和径向面积应变的整体（3DG）和节段（3DS）值。延迟钆增强（LGE）和MVO被量化为透壁（>50%）或非透壁（<50%）。通过受试者操作特征曲线下面积（AUC）评估预测性能。平均CMR左心室射血分数（LVEF）为45.8±9.2%，透壁LGE为22.2±12.7%。55例患者存在MVO（MVO透壁范围为11.4±11.8%）。在整体分析中，所有3DG应变值均与CMR LVEF和梗死面积相关，其中3DGAS相关性最佳（r = -0.678；p < 0.0001）。除LS外，所有3DG应变值在有和无MVO的患者之间均有显著差异。在节段分析中，透壁梗死节段的所有3DS应变值均显著低于非梗死节段，非透壁梗死节段中除3DSRS外的所有3DS值均显著低于非梗死节段。检测MVO>75%的无存活心肌节段的最佳3DS应变是3DSAS [AUC 0.867（0.849 - 0.884），3DSAS = -16.1%时灵敏度为78.0%，特异度为81.1%]。重要的是，与3DSLS相比，3DSRS和3DSAS可提高透壁LGE和MVO的诊断准确性（所有AUC增加>0.04，所有p < 0.01）。新开发的3DSTI，尤其是3DSAS，是预测和量化瘢痕透壁范围的敏感且可重复的工具。这种新的早期成像策略可改善对MVO的预测，同时能够评估再灌注的成功情况以及ST段抬高型心肌梗死（STEMI）晚期收缩期重塑的风险。
