Dursun Ihsan, Kul Selim, Sahin Sinan, Kalaycioglu Ezgi, Akyuz Ali Riza, Korkmaz Levent
Department of Cardiology, Saglik Bilimleri University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, 61040, Turkey.
Int J Cardiovasc Imaging. 2018 Apr;34(4):569-576. doi: 10.1007/s10554-017-1270-4. Epub 2017 Nov 9.
There are few reports demonstrating a relationship between presystolic wave (PSW) and left ventricular function. The aim of the present study was to investigate the associations between PSW and angiographic and echocardiographic characteristics of patients with acute myocardial infarction (AMI).
We studied 348 consecutive patients with AMI. Pulsed Doppler-echocardiography was used to assess the both diastolic functions and presence of PSW from left ventricular outflow tract. Patients were divided into two groups by the presence or absence of PSW. The Syntax score (SXscore) was calculated from baseline angiograms to assess the complexity and severity of coronary artery disease.
The overall prevalence of PSW was 51.1%. Compared to patients without PSW, patients with PSW presence had greater left ventricular ejection fraction (LVEF), greater septal a' velocity, lower mitral E and septal e' velocity and lower E/A and e'/a' ratios. Also, median SXscore were significantly lower in the PSW presence group compared to PSW absence group [1 (6-14) vs. 12 (7-18), P = 0.013]. In addition, the number of patients with high-SXscore (> 16) was significantly lower in PSW presence group (24 vs. 42), (P = 0.006). In multiple logistic regression analysis, absence of PSW found independent predictor of high-SXscore (OR 2.297 95% CI 1.235-4.272; P = 0.009).
We found that the presence of PSW was related with higher LVEF, lower SXscore and lower stage diastolic dysfunction in patients with AMI. PSW may be used in prediction of the coronary artery disease complexity and it could help risk stratification in patients with AMI.
很少有报告表明收缩前期波（PSW）与左心室功能之间存在关联。本研究的目的是探讨PSW与急性心肌梗死（AMI）患者的血管造影和超声心动图特征之间的关系。
我们研究了348例连续的AMI患者。使用脉冲多普勒超声心动图评估舒张功能以及左心室流出道PSW的存在情况。根据PSW的有无将患者分为两组。从基线血管造影计算Syntax评分（SXscore）以评估冠状动脉疾病的复杂性和严重程度。
PSW的总体患病率为51.1%。与无PSW的患者相比，有PSW的患者左心室射血分数（LVEF）更高，室间隔a'速度更高，二尖瓣E和室间隔e'速度更低，E/A和e'/a'比值更低。此外，有PSW组的中位数SXscore显著低于无PSW组[1（6 - 14）vs. 12（7 - 18），P = 0.013]。另外，有PSW组中高SXscore（> 16）患者的数量显著低于无PSW组（24 vs. 42），（P = 0.006）。在多因素逻辑回归分析中，无PSW是高SXscore的独立预测因素（OR 2.297，95% CI 1.235 - 4.272；P = 0.009）。
我们发现PSW的存在与AMI患者较高的LVEF、较低的SXscore和较低阶段的舒张功能障碍有关。PSW可用于预测冠状动脉疾病的复杂性，并有助于AMI患者的风险分层。
