Rumbinaitė Eglė, Žaliaduonytė-Pekšienė Diana, Vieželis Mindaugas, Čeponienė Indrė, Lapinskas Tomas, Žvirblytė Rūta, Venclovienė Jonė, Morkūnaitė Kristina, Bielinis Augustinas, Šlapikas Rimvydas, Vaškelytė Jolanta Justina
Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Medicina (Kaunas). 2016;52(6):331-339. doi: 10.1016/j.medici.2016.11.005. Epub 2016 Nov 25.
Myocardial deformation indices are considered as sensitive markers of ischemia and may be useful in the quantification of hemodynamic significance of coronary artery disease (CAD). We sought to determine the diagnostic value of speckle-tracking echocardiography derived myocardial deformation parameters at rest and during stress to determine hemodynamically significance coronary artery stenosis in patients with moderate and high probability of CAD.
In 81 patients (mean age, 64±8.6 years) with stable CAD inducible myocardial ischemia was evaluated by dobutamine stress echocardiography (DSE) and adenosine magnetic resonance imaging (AMRI). Based on AMRI patients were divided into two groups: nonpathologic (n=41) and pathologic (n=40). Strain and strain rate (SR) parameters and their changes from the rest (BASE) to low stress (MIN), peak stress (MAX), and recovery (REC) were analyzed using 2D speckle-tracking imaging (STI).
In the nonpathologic group, systolic longitudinal and circumferential strain increased significantly from BASE to MIN, as well as systolic SR from BASE to MIN and from MIN to MAX in longitudinal plane. In contrast, in the pathologic group, insignificant longitudinal systolic SR increase and radial and circumferential systolic SR decrease from MIN to MAX was observed. Discriminant function analysis revealed that select STI derived parameters best classify patients into predefined AMRI groups (pathologic and nonpathologic) with the accuracy respectively 90.9% and 83.3%. According to ROC analysis these myocardial deformation parameters had the greatest predictive value of significant coronary artery stenoses: longitudinal strain at high dose (AUC 0.811, sensitivity 89.4%, specificity 64.7%), longitudinal strain rate at high dose (AUC 0.855, sensitivity 88.1%, specificity 71.0% at high doses). The sensitivity and specificity of inducible wall motion abnormalities were 74.0% and 85.0% (AUC 0.798) and was lower compared with the diagnostic value of longitudinal myocardial deformation parameters.
Left ventricular strain and strain rate analyses during DSE can be used in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high risk for CAD.
心肌形变指标被视为缺血的敏感标志物，可能有助于量化冠状动脉疾病（CAD）的血流动力学意义。我们旨在确定斑点追踪超声心动图得出的静息及负荷状态下心肌形变参数对判断CAD中、高概率患者冠状动脉狭窄血流动力学意义的诊断价值。
对81例（平均年龄64±8.6岁）稳定型CAD患者进行多巴酚丁胺负荷超声心动图（DSE）及腺苷磁共振成像（AMRI）检查，以评估可诱导的心肌缺血情况。根据AMRI结果将患者分为两组：非病变组（n = 41）和病变组（n = 40）。采用二维斑点追踪成像（STI）分析应变及应变率（SR）参数，以及从静息（基础状态）到低负荷（最小负荷）、峰值负荷（最大负荷）和恢复阶段（恢复状态）的变化情况。
在非病变组中，从基础状态到最小负荷，收缩期纵向和圆周应变显著增加，纵向平面上从基础状态到最小负荷以及从最小负荷到最大负荷时收缩期SR也显著增加。相比之下，在病变组中，观察到从最小负荷到最大负荷时纵向收缩期SR增加不显著，径向和圆周收缩期SR下降。判别函数分析显示，选择STI得出的参数能将患者最佳地分类到预先定义的AMRI组（病变组和非病变组），准确率分别为90.9%和83.3%。根据ROC分析，这些心肌形变参数对显著冠状动脉狭窄具有最大预测价值：高剂量时纵向应变（AUC 0.811，敏感性89.4%，特异性64.7%），高剂量时纵向应变率（AUC 0.855，敏感性88.1%，高剂量时特异性71.0%）。可诱导性室壁运动异常的敏感性和特异性分别为74.0%和85.0%（AUC 0.798），与纵向心肌形变参数的诊断价值相比更低。
DSE期间的左心室应变及应变率分析可用于评估CAD中、高风险患者冠状动脉狭窄的血流动力学意义。
