Keddeas Viola William, Swelim Salwa Mohammed, Selim Ghada Kamel
Ain Shams University, Egypt.
Egypt Heart J. 2017 Jun;69(2):103-110. doi: 10.1016/j.ehj.2016.10.005. Epub 2016 Nov 1.
A substantial fraction of patients with non ST-elevation acute coronary syndrome have an occluded culprit vessel on coronary angiography. Acute coronary occlusion often results in myocardial infarction and loss of systolic function. Identification of these patients may have considerable impact on treatment and prognosis.
The study aims at investigating role of 2D speckle tracking echocardiography as a non-invasive predictor of acute coronary artery occlusion in patients with non ST-segment elevation myocardial infarction.
This study was carried on 60 patients with first attack non ST segment elevation myocardial infarction who were admitted to coronary care unit of Ain Shams University Hospitals. All patients underwent thorough history taking, full clinical examination, 12 leads surface ECG, full 2D, M-mode and Doppler echocardiographic study, two-dimensional speckle tracking strain study and coronary angiography.
2D derived peak global longitudinal strain had a highly significant relationship in prediction of the presence of total occlusion, and also number of segments with reduced strain (functional risk area by strain) had a highly significant relationship in prediction of the presence of total occlusion. In this study, 2D derived peak longitudinal strain sensitivity and specificity were 68.9% and 77.7% respectively at a cutoff value of -15.5 while number of segments with reduced longitudinal strain sensitivity and specificity were 63.6% and 77.7% respectively at a cutoff value of 5 segments.
Both global and regional peak longitudinal systolic strain can offer accurate, feasible, and non-invasive predictor for acute coronary artery occlusion in patients with non ST elevation myocardial infarction who may benefit from early revascularization.
相当一部分非ST段抬高型急性冠状动脉综合征患者在冠状动脉造影时存在罪犯血管闭塞。急性冠状动脉闭塞常导致心肌梗死和收缩功能丧失。识别这些患者可能对治疗和预后产生重大影响。
本研究旨在探讨二维斑点追踪超声心动图作为非ST段抬高型心肌梗死患者急性冠状动脉闭塞无创预测指标的作用。
本研究对60例首次发作的非ST段抬高型心肌梗死患者进行，这些患者入住艾因夏姆斯大学医院冠心病监护病房。所有患者均接受了详细的病史采集、全面的临床检查、12导联体表心电图、完整的二维、M型和多普勒超声心动图检查、二维斑点追踪应变研究以及冠状动脉造影。
二维衍生的整体纵向峰值应变在预测完全闭塞的存在方面具有高度显著的相关性，并且应变降低的节段数（应变功能风险区域）在预测完全闭塞的存在方面也具有高度显著的相关性。在本研究中，二维衍生的纵向峰值应变敏感性和特异性在临界值为-15.5时分别为68.9%和77.7%，而纵向应变降低的节段数敏感性和特异性在临界值为5个节段时分别为63.6%和77.7%。
整体和局部纵向收缩期峰值应变均可为可能从早期血运重建中获益的非ST段抬高型心肌梗死患者的急性冠状动脉闭塞提供准确、可行的无创预测指标。
