急性 ST 段抬高型心肌梗死患者梗死部位与左心室旋转参数的关系。

Relationship between the infarct localization and left ventricular rotation parameters following acute ST-segment elevation myocardial infarction.

机构信息

Department of Cardiology, Çorlu State Hospital, Tekirdağ, Turkey.

Department of Biostatistics, Namık Kemal University Faculty of Medicine, Tekirdağ, Turkey.

出版信息

Turk Kardiyol Dern Ars. 2020 Apr;48(3):255-262. doi: 10.5543/tkda.2019.36422.

DOI:10.5543/tkda.2019.36422

PMID:32281952

Abstract

OBJECTIVE

This study was an investigation of the role of left ventricular (LV) apical rotation seen in the early period after myocardial infarction (MI) in predicting infarct localization.

METHODS

A total of 124 patients with a ST-Segment elevation myocardial infarction (STEMI) diagnosis who underwent primary percutaneous coronary intervention (PCI) and 50 healthy volunteers with similar demographic characteristics were included in the study. The relationship between 2-dimenstional speckle tracking echocardiography (STE)-guided LV apical rotation angle measurements and technetium-99m sestamibi-single-photon emission computed tomography (SPECT)-guided infarct localization was evaluated. Conventional echocardiography and STE were performed on average 2 days after PCI, and gated SPECT myocardial perfusion imaging (MPI) was performed within an average of 60 days.

RESULTS

The apical rotation angle was lower in patients with an anterior MI compared with those who had an inferior MI and the control group (AntMI-InfMI: 6.51±2.4°, AntMI-Control: 13.20±2.5°, InfMI-Control: 14.3±2.1°; p value: 0.00, 0.00, 0.15, respectively). SPECT MPI analysis revealed the presence of an LV apical scar in all patients with acute anterior MI, but only 14 of those with inferior MI group (usually the inferoapical wall). The apical rotation angle recorded in patients with apical scar was lower than that of the patients without apical scar (7.6±2.8° and 14.5±2°, respectively; p=0.00). Receiver operating characteristic curve analysis yielded an area under the curve for apical rotation of 0.799 (p<0.01). The optimal cutoff value of 12.1° had a sensitivity of 78.3% and a specificity of 68.2% for predicting LV apical scar following STEMI.

CONCLUSION

Detection of apical rotation angle decrease in the early period after STEMI may be useful in predicting extension of infarct scarring to the LV apex.

摘要

目的

本研究旨在探讨心肌梗死后早期左心室（LV）心尖旋转在预测梗死部位中的作用。

方法

共纳入 124 例接受直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者和 50 名具有相似人口统计学特征的健康志愿者。评估二维斑点追踪超声心动图（STE）引导的 LV 心尖旋转角度测量值与锝-99m 甲氧基异丁基异腈单光子发射计算机断层扫描（SPECT）引导的梗死定位之间的关系。平均在 PCI 后 2 天行常规超声心动图和 STE 检查，平均在 60 天内行门控 SPECT 心肌灌注成像（MPI）检查。

结果

与下壁心肌梗死和对照组相比，前壁心肌梗死患者的心尖旋转角度较低（前壁心肌梗死-下壁心肌梗死：6.51±2.4°，前壁心肌梗死-对照组：13.20±2.5°，下壁心肌梗死-对照组：14.3±2.1°；p 值：0.00，0.00，0.15）。SPECT MPI 分析显示，所有急性前壁心肌梗死患者均存在 LV 心尖瘢痕，但下壁心肌梗死组中仅 14 例患者（通常为下壁心尖部）存在心尖瘢痕。有心尖瘢痕的患者心尖旋转角度低于无心尖瘢痕的患者（分别为 7.6±2.8°和 14.5±2°；p=0.00）。受试者工作特征曲线分析显示，心尖旋转的曲线下面积为 0.799（p<0.01）。12.1°的最佳截断值预测 STEMI 后 LV 心尖瘢痕的灵敏度为 78.3%，特异性为 68.2%。