Mele Donato, Nardozza Marianna, Chiodi Elisabetta
Department of Emergency, Noninvasive Cardiology Unit, University Hospital of Ferrara, Ferrara, Italy.
Department of Imaging and Laboratory Medicine, Radiology Unit, University Hospital of Ferrara, Ferrara, Italy.
J Cardiovasc Echogr. 2017 Jul-Sep;27(3):93-98. doi: 10.4103/jcecho.jcecho_2_17.
Prediction of the left ventricular remodeling (LVR) after ST-segment elevation myocardial infarction (STEMI) in patients treated with effective myocardial reperfusion is challenging.
Forty-one consecutive patients (36 males, age 59 ± 10 years) with STEMI who underwent effective (TIMI III) primary coronary angioplasty were enrolled. All patients had an echocardiography and cardiac magnetic resonance (CMR) study within 72 h from revascularization. Three echocardiographic parameters including LV ejection fraction (EF), global longitudinal strain (GLS) and severe altered longitudinal strain (SAS) area by two-dimensional speckle-tracking echocardiography (2D-STE) and 3 CMR indices including LV global function index (LV-GFI), myocardial salvage index (MSI), and microvascular obstruction (MVO) were calculated. LVR was defined as an increase in CMR LV end-diastolic volume (EDV) >15% after 6 months.
Of 41 patients, 10 (24%) had LVR (LV-EDV from 145.1 ± 29.3 to 185.9 ± 49.8 ml, < 0.001). A significant correlation with LV-EDV variation was found for baseline SAS area ( = 0.81), LV-GFI ( = -0.56), MVO ( = 0.55), EF ( = -0.42), GLS ( = 0.42), not for MSI ( = -0.25). At the multivariable analysis, a significant correlation remained only for the SAS area. The receiver-operating characteristic curve analysis showed that a baseline SAS area ≥15% predicts LVR with a sensitivity of 80.0% and a specificity of 90.3%.
The SAS area evaluated by 2D-STE early in acute STEMI is a valuable predictor of LVR after 6 months. Further investigations are needed to verify its value in predicting patient survival.
对于接受有效心肌再灌注治疗的ST段抬高型心肌梗死（STEMI）患者，预测其左心室重构（LVR）具有挑战性。
连续纳入41例接受有效（TIMI III级）直接冠状动脉血管成形术的STEMI患者（36例男性，年龄59±10岁）。所有患者在血运重建后72小时内接受了超声心动图和心脏磁共振（CMR）检查。通过二维斑点追踪超声心动图（2D-STE）计算三个超声心动图参数，包括左心室射血分数（EF）、整体纵向应变（GLS）和严重纵向应变改变（SAS）面积，以及三个CMR指标，包括左心室整体功能指数（LV-GFI）、心肌挽救指数（MSI）和微血管阻塞（MVO）。LVR定义为6个月后CMR左心室舒张末期容积（EDV）增加＞15%。
41例患者中，10例（24%）发生LVR（左心室EDV从145.1±29.3 ml增至185.9±49.8 ml，P＜0.001）。发现基线SAS面积（r = 0.81）、LV-GFI（r = -0.56）、MVO（r = 0.55）、EF（r = -0.42）、GLS（r = 0.42）与左心室EDV变化存在显著相关性，而MSI（r = -0.25）无相关性。在多变量分析中，仅SAS面积仍存在显著相关性。受试者工作特征曲线分析显示，基线SAS面积≥15%预测LVR的敏感性为80.0%，特异性为90.3%。
急性STEMI早期通过2D-STE评估的SAS面积是6个月后LVR的有价值预测指标。需要进一步研究以验证其在预测患者生存方面的价值。
