Na Hyun-Min, Cho Goo-Yeong, Lee Joo Myung, Cha Myung-Jin, Yoon Yeonyee E, Lee Seung-Pyo, Kim Hyung-Kwan, Kim Yong-Jin, Sohn Dae-Won
College of Medicine, Seoul National University, Seoul, Korea.
Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
J Cardiovasc Ultrasound. 2016 Jun;24(2):128-34. doi: 10.4250/jcu.2016.24.2.128. Epub 2016 Jun 22.
We sought to assess echocardiographic predictors of left ventricular (LV) adverse remodeling after successfully reperfused acute ST elevation myocardial infarction (STEMI). LV remodeling is commonly found in STEMI patients and it may suggest adverse outcome in acute myocardial infarction. We sought to identify whether 2D strain and torsion be independent parameters for prediction of LV adverse remodeling.
We investigated 208 patients with low-risk STEMI patients who had follow up echocardiography at 6 or more months. After clinical assessments, all patients received revascularization according to current guideline. LV remodeling was defined as > 20% increase in end-diastolic volume (EDV) at follow up.
During the follow-up (11.9 ± 5.3 months), 53 patients (25.5%) showed LV remodeling. In univariate analysis, EDV, end-systolic volume, deceleration time (DT), CK-MB, and global longitudinal strain (GLS) were associated with LV remodeling. In multivariate analysis, EDV [hazard ratio (HR): 0.922, 95% confidence interval (CI): 0.897-0.948, p< 0.001],
GLS (HR: 0.842, 95% CI: 0.728-0.974, p = 0.020), DT (HR: 0.989, 95% CI: 0.980-0.998, p = 0.023) and CK-MB (HR: 1.003, 95% CI: 1.000-1.005, p = 0.033) independently predicted LV remodeling. However, global circumferential strain, net twist, and twist or untwist rate were not associated with remodeling.
Of various parameters of speckle strain, only GLS predicted adverse remodeling in STEMI patients.
我们试图评估成功再灌注的急性ST段抬高型心肌梗死（STEMI）患者左心室（LV）不良重构的超声心动图预测指标。LV重构在STEMI患者中很常见，它可能提示急性心肌梗死的不良预后。我们试图确定二维应变和扭转是否为预测LV不良重构的独立参数。
我们调查了208例低风险STEMI患者，这些患者在6个月或更长时间后接受了超声心动图随访。经过临床评估后，所有患者均按照现行指南接受血运重建。LV重构定义为随访时舒张末期容积（EDV）增加>20%。
在随访期间（11.9±5.3个月），53例患者（25.5%）出现LV重构。在单因素分析中，EDV、收缩末期容积、减速时间（DT）、肌酸激酶同工酶（CK-MB）和整体纵向应变（GLS）与LV重构相关。在多因素分析中，EDV[风险比（HR）：0.922，95%置信区间（CI）：0.897-0.948，p<0.001]、GLS（HR：0.842，95%CI：0.728-0.974，p = 0.020）、DT（HR：0.989，95%CI：0.980-0.998，p = 0.023）和CK-MB（HR：1.003，95%CI：1.000-1.005，p = 0.033）独立预测LV重构。然而，整体圆周应变、净扭转以及扭转或解扭转率与重构无关。
在散斑应变的各种参数中，只有GLS可预测STEMI患者的不良重构。
