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通过多维心震图评估透壁性心肌梗死期间心脏动能及其变化的定量分析

Quantification of Cardiac Kinetic Energy and Its Changes During Transmural Myocardial Infarction Assessed by Multi-Dimensional Seismocardiography.

作者信息

Morra Sofia, Pitisci Lorenzo, Su Fuhong, Hossein Amin, Rabineau Jérémy, Racape Judith, Gorlier Damien, Herpain Antoine, Migeotte Pierre-François, Creteur Jacques, van de Borne Philippe

机构信息

Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.

Experimental Laboratory of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.

出版信息

Front Cardiovasc Med. 2021 Mar 8;8:603319. doi: 10.3389/fcvm.2021.603319. eCollection 2021.

Abstract

Seismocardiography (SCG) records cardiac and blood-induced motions transmitted to the chest surface as vibratory phenomena. Evidences demonstrate that acute myocardial ischemia (AMI) profoundly affects the SCG signals. Multidimensional SCG records cardiac vibrations in linear and rotational dimensions, and scalar parameters of kinetic energy can be computed. We speculate that AMI and revascularization profoundly modify cardiac kinetic energy as recorded by SCG. Under general anesthesia, 21 swine underwent 90 min of myocardial ischemia induced by percutaneous sub-occlusion of the proximal left anterior descending (LAD) coronary artery and subsequent revascularization. Invasive hemodynamic parameters were continuously recorded. SCG was recorded during baseline, immediately and 80 min after LAD sub-occlusion, and immediately and 60 min after LAD reperfusion. K was automatically computed for each cardiac cycle ( ) in linear ( ) and rotational ( ) dimensions. K was calculated as well during systole and diastole ( and , respectively). Echocardiography was performed at baseline and after revascularization, and the left ventricle ejection fraction (LVEF) along with regional left ventricle (LV) wall abnormalities were evaluated. Upon LAD sub-occlusion, 77% of STEMI and 24% of NSTEMI were observed. Compared to baseline, troponins increased from 13.0 (6.5; 21.3) ng/dl to 170.5 (102.5; 475.0) ng/dl, and LVEF dropped from 65.0 ± 0.0 to 30.6 ± 5.7% at the end of revascularization (both < 0.0001). Regional LV wall abnormalities were observed as follows: anterior MI, 17.6% (three out of 17); septal MI, 5.8% (one out of 17); antero-septal MI, 47.1% (eight out of 17); and infero-septal MI, 29.4% (five out of 17). In the linear dimension, , , and dropped by 43, 52, and 53%, respectively ( < 0.0001, < 0.0001, and = 0.03, respectively) from baseline to the end of reperfusion. In the rotational dimension, and dropped by 30 and 36%, respectively ( = 0.0006 and < 0.0001, respectively), but did not change ( = 0.41). All the hemodynamic parameters, except the pulmonary artery pulse pressure, were significantly correlated with the parameters of , except for the diastolic component. In this very context of experimental AMI with acute LV regional dysfunction and no concomitant AMI-related heart valve disease, linear and rotational K parameters, in particular, systolic ones, provide reliable information on LV contractile dysfunction and its effects on the downstream circulation. Multidimensional SCG may provide information on the cardiac contractile status expressed in terms of K during AMI and reperfusion. This automatic system may empower health care providers and patients to remotely monitor cardiovascular status in the near future.

摘要

地震心音描记术(SCG)将心脏及血液引起的运动作为振动现象记录到胸壁表面。有证据表明,急性心肌缺血(AMI)会对SCG信号产生深远影响。多维SCG可记录心脏在直线和旋转维度上的振动,并能计算动能的标量参数。我们推测,AMI和血运重建会显著改变SCG记录的心脏动能。在全身麻醉下,对21头猪进行经皮近端左前降支(LAD)冠状动脉次闭塞诱导的90分钟心肌缺血及随后的血运重建。持续记录有创血流动力学参数。在基线期、LAD次闭塞后即刻及80分钟、LAD再灌注后即刻及60分钟记录SCG。针对每个心动周期( ),自动计算直线( )和旋转( )维度的K值。还分别计算了收缩期和舒张期(分别为 和 )的K值。在基线期和血运重建后进行超声心动图检查,评估左心室射血分数(LVEF)及左心室(LV)壁节段性异常情况。LAD次闭塞时,观察到77%的ST段抬高型心肌梗死(STEMI)和24%的非ST段抬高型心肌梗死(NSTEMI)。与基线相比,肌钙蛋白从13.0(6.5;21.3)ng/dl升至170.5(102.5;475.0)ng/dl,血运重建结束时LVEF从65.0±0.0降至30.6±5.7%(两者均 < 0.0001)。观察到的LV壁节段性异常情况如下:前壁心肌梗死,17.6%(17例中的3例);间隔心肌梗死,5.8%(17例中的1例);前间隔心肌梗死,47.1%(17例中的8例);下间隔心肌梗死,29.4%(17例中的5例)。在直线维度上,从基线到再灌注结束时, 、 和 分别下降了43%、52%和53%(分别为 < 0.0001、 < 0.0001和 = 0.03)。在旋转维度上, 和 分别下降了30%和36%(分别为 = 0.0006和 < 0.0001),但 未改变( = 0.41)。除肺动脉脉压外,所有血流动力学参数均与 的参数显著相关,但与舒张期成分无关。在这种伴有急性LV节段性功能障碍且无相关AMI心脏瓣膜病的实验性AMI背景下,直线和旋转K参数,尤其是收缩期参数,可提供有关LV收缩功能障碍及其对下游循环影响的可靠信息。多维SCG可提供有关AMI和再灌注期间用K表示的心脏收缩状态的信息。这种自动系统可能使医护人员和患者在不久的将来能够远程监测心血管状态。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d24/7982421/dad61bb43abf/fcvm-08-603319-g0001.jpg

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