定量壁运动分析在急诊科急性胸痛患者中的作用

Role of Quantitative Wall Motion Analysis in Patients with Acute Chest Pain at Emergency Department.

作者信息

Kim Kyung-Hee, Na Sang-Hoon, Park Jin-Sik

机构信息

Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea.

Division of Cardiology, Department of internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.; Institute on Aging, Seoul National University, Seoul, Korea.

出版信息

J Cardiovasc Ultrasound. 2017 Mar;25(1):20-27. doi: 10.4250/jcu.2017.25.1.20. Epub 2017 Mar 27.

DOI:10.4250/jcu.2017.25.1.20

PMID:28400932

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5385313/

Abstract

BACKGROUND

Evaluation of acute chest pain in emergency department (ED), using limited resource and time, is still very difficult despite recent development of many diagnostic tools. In this study, we tried to determine the applicability of new semi-automated cardiac function analysis tool, velocity vector imaging (VVI), in the evaluation of the patients with acute chest pain in ED.

METHODS

We prospectively enrolled 48 patients, who visited ED with acute chest pain, and store images to analyze VVI from July 2005 to July 2007.

RESULTS

In 677 of 768 segments (88%), the analysis by VVI was feasible among 48 patients. Peak systolic radial velocity (V) and strain significantly decreased according to visual regional wall motion abnormality (V, 3.50 ± 1.34 cm/s for normal vs. 3.46 ± 1.52 cm/s for hypokinesia, 2.51 ± 1.26 for akinesia, < 0.01; peak systolic radial strain -31.74 ± 9.15% fornormal, -24.33 ± 6.28% for hypokinesia, -20.30 ± 7.78% for akinesia, < 0.01). However, the velocity vectors at the time of mitral valve opening (MVO) were directed outward in the visually normal myocardium, inward velocity vectors were revealed in the visually akinetic area (V, -0.85 ± 1.65 cm/s for normal vs. 0.10 ± 1.46 cm/s for akinesia, < 0.001). At coronary angiography, V clearly increased in the ischemic area (V, -0.88+1.56 cm/s for normal vs. 0.70 + 2.04 cm/s for ischemic area, < 0.01).

CONCLUSION

Regional wall motion assessment using VVI showed could be used to detect significant ischemia in the patient with acute chest pain at ED.

摘要

背景

尽管近年来出现了许多诊断工具，但在急诊科（ED）利用有限的资源和时间对急性胸痛进行评估仍然非常困难。在本研究中，我们试图确定新的半自动心功能分析工具——速度向量成像（VVI）在急诊科急性胸痛患者评估中的适用性。

方法

我们前瞻性纳入了48例因急性胸痛就诊于急诊科的患者，并于2005年7月至2007年7月存储图像以分析VVI。

结果

在48例患者的768个节段中，677个节段（88%）的VVI分析是可行的。根据视觉上的节段性室壁运动异常，收缩期峰值径向速度（V）和应变显著降低（正常节段V为3.50±1.34cm/s，运动减弱节段为3.46±1.52cm/s，运动消失节段为2.51±1.26cm/s，P<0.01；收缩期峰值径向应变正常节段为-31.74±9.15%，运动减弱节段为-24.33±6.28%，运动消失节段为-20.30±7.78%，P<0.01）。然而，二尖瓣开放（MVO）时视觉上正常心肌区域的速度向量向外，而在视觉上运动消失区域则显示向内的速度向量（正常节段V为-0.85±1.65cm/s，运动消失节段为0.10±1.46cm/s，P<0.001）。在冠状动脉造影时，缺血区域的V明显增加（正常节段V为-0.88+1.56cm/s，缺血区域为0.70+2.04cm/s，P<0.01）。