Shetye Abhishek, Nazir Sheraz A, Squire Iain B, McCann Gerald P
Abhishek Shetye, Sheraz A Nazir, Iain B Squire, Gerald P McCann, Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester LE3 9QP, United Kingdom.
World J Cardiol. 2015 Dec 26;7(12):948-60. doi: 10.4330/wjc.v7.i12.948.
To conduct a systematic review relating myocardial strain assessed by different imaging modalities for prognostication following ST-elevation myocardial infarction (STEMI).
An online literature search was performed in PubMed and OVID(®) electronic databases to identify any studies that assessed global myocardial strain parameters using speckle-tracking echocardiography (STE) and/or cardiac magnetic resonance imaging (CMR) techniques [either myocardial tagging or feature tracking (FT) software] in an acute STEMI cohort (days 0-14 post-event) to predict prognosis [either development of major adverse cardiac events (MACE)] or adverse left ventricular (LV) remodelling at follow-up (≥ 6 mo for MACE, ≥ 3 mo for remodelling). Search was restricted to studies within the last 20 years. All studies that matched the pre-defined search criteria were reviewed and their results interpreted. Due to considerable heterogeneity between studies, meta-analysis was not performed.
A total of seven studies (n = 7) were identified that matched the search criteria. All studies used STE to evaluate strain parameters - five (n = 5) assessed global longitudinal strain (GLS) (n = 5), one assessed GLS rate (GLS-R) (n = 1) and one assessed both (n = 1). Three studies showed that GLS independently predicted the development of adverse LV remodelling by multivariate analysis - odds ratio between 1.19 (CI: 1.04-1.37, P < 0.05) and 10 (CI: 6.7-14, P < 0.001) depending on the study. Four studies showed that GLS predicted the development of MACE - hazard ratio (HR) between 1.1 (CI: 1-1.1, P = 0.006) and 2.34 (1.10-4.97, P < 0.05). One paper found that GLS-R could significantly predict MACE - HR 18 (10-35, P < 0.001) - whilst another showed it did not. GLS < -10.85% had sensitivity/specificity of 89.7%/91% respectively for predicting the development of remodelling whilst GLS < -13% could predict the development of MACE with sensitivity/specificity of 100%/89% respectively. No suitable studies were identified that assessed global strain by CMR tagging or FT techniques.
GLS measured acutely post-STEMI by STE is a predictor of poor prognosis. Further research is needed to show that this is true for CMR-based techniques.
对通过不同成像方式评估心肌应变以预测ST段抬高型心肌梗死（STEMI）后预后的相关研究进行系统评价。
在PubMed和OVID（®）电子数据库中进行在线文献检索，以确定在急性STEMI队列（事件发生后0至14天）中使用斑点追踪超声心动图（STE）和/或心脏磁共振成像（CMR）技术[心肌标记或特征追踪（FT）软件]评估整体心肌应变参数以预测预后[主要不良心脏事件（MACE）的发生或随访时左心室（LV）不良重塑（MACE为≥6个月，重塑为≥3个月）]的任何研究。检索限于过去20年内的研究。对所有符合预定义检索标准的研究进行综述并解释其结果。由于研究之间存在相当大的异质性，未进行荟萃分析。
共确定了7项符合检索标准的研究（n = 7）。所有研究均使用STE评估应变参数——5项（n = 5）评估整体纵向应变（GLS）（n = 5），1项评估GLS率（GLS - R）（n = 1），1项同时评估两者（n = 1）。3项研究表明，通过多变量分析，GLS可独立预测LV不良重塑的发生——根据研究不同，比值比在1.19（CI：1.04 - 1.37，P < 0.05）至10（CI：6.7 - 14，P < 0.001）之间。4项研究表明，GLS可预测MACE的发生——风险比（HR）在1.1（CI：1 - 1.1，P = 0.006）至2.34（1.10 - 4.97，P < 0.05）之间。一篇论文发现GLS - R可显著预测MACE——HR为18（10 - 35，P < 0.001），而另一篇论文表明其不能。GLS < - 10.85%预测重塑发生的敏感性/特异性分别为89.7%/91%，而GLS < - 13%预测MACE发生的敏感性/特异性分别为100%/89%。未发现通过CMR标记或FT技术评估整体应变的合适研究。
STEMI后急性期通过STE测量的GLS是预后不良的预测指标。需要进一步研究以表明基于CMR的技术也是如此。
