负荷超声心动图检查时的短暂性心肌缺血性扩张：严重心肌缺血的另一个标志物

Transient Ischemic Dilatation during Stress Echocardiography: An Additional Marker of Significant Myocardial Ischemia.

作者信息

Kataoka Akihisa, Scherrer-Crosbie Marielle, Senior Roxy, Garceau Patrick, Valbuena Silvia, Čelutkienė Jelena, Hastings Jeffrey L, Cheema Asim N, Lara Alfonso, Srbinovska-Kostovska Elizabeta, Hessian Renee, Poggio Daniele, Goldweit Richard, Saric Muhamed, Dajani Khaled A, Kohn Jeffrey A, Shaw Leslee J, Reynolds Harmony R, Picard Michael H

机构信息

Cardiac Ultrasound Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.

Department of Cardiovascular Medicine, Division of Cardiology, National Heart and Lung Institute and Imperial College, London, United Kingdom.

出版信息

Echocardiography. 2016 Aug;33(8):1202-8. doi: 10.1111/echo.13222. Epub 2016 Apr 3.

DOI:10.1111/echo.13222

PMID:27040889

Abstract

AIM

Left ventricular (LV) transient ischemic dilatation (TID) is not clear how it relates to inducible myocardial ischemia during stress echocardiography (SE).

METHODS AND RESULTS

Eighty-eight SEs were examined from the site certification phase of the ISCHEMIA Trial. LV end-diastolic volume (EDV) and end-systolic volume (ESV) were measured at rest and peak stages and the percent change calculated. Moderate or greater ischemia was defined as ≥3 segments with stress-induced severe hypokinesis or akinesis. Optimum cut points in stress-induced percent EDV and ESV change that identified moderate or greater myocardial ischemia were analyzed. Analysis from percentage distribution identified a > 13% LV volume increase in EDV or a > 9% LV volume increase in ESV as the optimum cutoff points for moderate or greater ischemia. Using these definitions for TID, there were 27 (31%) with TIDESV and 12 (14%) with TIDEDV . By logistic regression analysis and receiver operating characteristic curves, the percent change in ESV had a stronger association with moderate or greater myocardial ischemia than that of EDV change. Compared to those without TIDESV , cases with TIDESV had larger extent of inducible wall-motion abnormalities, lower peak stress LVEF, and higher likelihood of moderate or grater ischemia. For moderate or greater myocardial ischemia detection, TIDESV had a sensitivity of 46%, specificity of 83%, positive predictive value of 70%, and negative predictive value of 64%.

CONCLUSION

Transient ischemic dilatation by SE is a marker of extensive myocardial ischemia and can be used as an additional marker of higher risk.

摘要

目的

左心室（LV）短暂性缺血性扩张（TID）与负荷超声心动图（SE）期间的诱发性心肌缺血之间的关系尚不清楚。

方法与结果

从缺血性心脏病（ISCHEMIA）试验的现场认证阶段检查了88例SE。在静息和峰值阶段测量左心室舒张末期容积（EDV）和收缩末期容积（ESV），并计算变化百分比。中度或更严重的缺血定义为≥3个节段出现负荷诱发的严重运动减弱或运动消失。分析了负荷诱发的EDV和ESV变化百分比中识别中度或更严重心肌缺血的最佳切点。通过百分比分布分析确定，EDV中左心室容积增加>13%或ESV中左心室容积增加>9%为中度或更严重缺血的最佳切点。使用这些TID定义，有27例（31%）出现TID-ESV，12例（14%）出现TID-EDV。通过逻辑回归分析和受试者工作特征曲线，ESV的变化百分比与中度或更严重心肌缺血的相关性比EDV变化更强。与没有TID-ESV的患者相比，有TID-ESV的患者诱发性室壁运动异常范围更大，峰值负荷左心室射血分数（LVEF）更低，中度或更严重缺血的可能性更高。对于中度或更严重心肌缺血的检测，TID-ESV的敏感性为46%，特异性为83%，阳性预测值为70%；阴性预测值为64%。