二维斑点追踪超声心动图预测射血分数保留的急性心肌梗死患者左心室重构情况
Two-Dimensional Speckle Tracking Echocardiography Predict Left Ventricular Remodeling after Acute Myocardial Infarction in Patients with Preserved Ejection Fraction.
作者信息
Hsiao Ju-Feng, Chung Chang-Min, Chu Chi-Ming, Lin Yu-Shen, Pan Kuo-Li, Chang Shih-Tai, Hsu Jen-Te
机构信息
The Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Pu-Tz City, Chai Yi Hsien, Taiwan.
Section of Health Informatics, Institute of Public Health, National Defense Medical Center and University, Taipei, Taiwan.
出版信息
PLoS One. 2016 Dec 29;11(12):e0168109. doi: 10.1371/journal.pone.0168109. eCollection 2016.
OBJECTIVES
Left ventricular remodeling after acute myocardial infarction increases cardiovascular events and mortality. But few study was done in patients with preserved ejection fraction (EF > 40%). We investigate whether the strain and strain rate by 2D speckle tracking echocardiography could predict left ventricular remodeling after acute myocardial infarction in this cohort.
METHODS
The 83 patients (average age 60.7 ± 12.3 y, 75 [90.4%] male) with new-onset acute myocardial infarction receiving echocardiography immediately, and 6 months after admission were grouped by the presence or absence of left ventricular remodeling. Strain and strain rate including longitudinal, circumferential, and radial direction were calculated. The average of strain and strain rate of which segmental longitudinal strains > - 15% were defined as the injury longitudinal strain (InjLS).
RESULTS
Left ventricular remodeling occurred in 24 of 83 patients (28.9%). In univariate logistic regression analyses, gender, peak CK-MB, log BNP, use of statin before discharge, wall motion score index, and InjLS were significantly associated with left ventricular remodeling (p < 0.05). In multivariate analysis using the forward stepwise method, gender, CK-MB, and InjLS were independent predictors. The hazard ratio for InjLS was 1.48 (p = 0.04). Receiver operating characteristic curve (ROC) analyses showed the area under the curve (AUC) of InjLS was largest (AUC = 0.75, cut-off value = -11.7%, sensitivity = 81%, specificity = 71%, p < 0.01). In ST-segment elevation myocardial infarction subgroup, InjLS was the only predictor according to ROC analysis (AUC = 0.79, p < 0.01, cut-off value = -11.4%, sensitivity = 88%, specificity = 77%) and multivariate logistic regression analysis (hazard ratio = 1.88, 95% CI: 1.22-2.88, p < 0.01).
CONCLUSIONS
InjLS was an excellent predictor for left ventricular remodeling after acute myocardial infarction in patient with preserved ejection fraction.
目的
急性心肌梗死后左心室重构会增加心血管事件及死亡率。但针对射血分数保留（EF>40%）患者的研究较少。我们在该队列中研究二维斑点追踪超声心动图测量的应变及应变率能否预测急性心肌梗死后左心室重构。
方法
83例新发急性心肌梗死患者（平均年龄60.7±12.3岁，75例[90.4%]为男性）在入院时及入院6个月后立即接受超声心动图检查，并根据有无左心室重构进行分组。计算包括纵向、圆周和径向方向的应变及应变率。节段纵向应变>-15%的应变及应变率平均值定义为损伤纵向应变（InjLS）。
结果
83例患者中有24例（28.9%）发生左心室重构。在单因素逻辑回归分析中，性别、CK-MB峰值、log BNP、出院前他汀类药物使用情况、室壁运动评分指数及InjLS与左心室重构显著相关（p<0.05）。在采用向前逐步法的多因素分析中，性别、CK-MB及InjLS为独立预测因素。InjLS的风险比为1.48（p=0.04）。受试者工作特征曲线（ROC）分析显示InjLS的曲线下面积（AUC）最大（AUC=0.75，截断值=-11.7%，敏感性=81%，特异性=71%，p<0.01）。在ST段抬高型心肌梗死亚组中，根据ROC分析（AUC=0.79，p<0.01，截断值=-11.4%，敏感性=88%，特异性=77%）及多因素逻辑回归分析（风险比=1.88，95%CI：1.22-2.88，p<0.01），InjLS是唯一的预测因素。
结论
InjLS是射血分数保留的急性心肌梗死患者左心室重构的优秀预测指标。
Zotero 插件