Early prediction of infarct size by strain Doppler echocardiography after coronary reperfusion
Early prediction of infarct size by strain Doppler echocardiography after coronary reperfusion
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DOI：
10.1016/j.jacc.2006.12.047
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发表时间：
2007-04-24
影响因子：
24
通讯作者：
Edvardsen, Thor
中科院分区：
文献类型：
--
作者：
Vartdal, Trond;Brunvand, Harald;Edvardsen, Thor
目的 本研究的目的是探讨经皮冠状动脉介入治疗血运重建后立即进行的应变多普勒超声心动图是否可以预测心肌疤痕的程度，通过对比增强磁共振成像 (MRI) 确定。 背景 经皮冠状动脉介入治疗后的生存率存在相当大的变异性，因此准确的早期风险分层具有重要的临床意义。 方法 30 急性前壁心肌梗死患者在血运重建后 1.5 小时通过多普勒进行纵向应变检查。 9个月后，通过MRI分析16个相应心肌节段的疤痕形成程度。对所有左心室节段的应变进行平均以获得全局值。通过临床参数和心脏标志物估计梗死面积。方法对30例急性前壁心肌梗死患者在血运重建后1.5小时进行多普勒纵向应变检查。 9个月后，通过MRI分析16个相应心肌节段的疤痕形成程度。对所有左心室节段的应变进行平均以获得全局值。通过临床参数和心脏标志物估计梗塞面积。结果发现整体应变和总梗塞面积之间存在良好的相关性（R = 0.77，p < 0.00001）。多变量回归分析显示，总体峰值应变和血清谷草酰乙酸转氨酶与 MRI 测量的梗塞面积相关（分别为 p = 0.0001 和 p = 0.001）。此外，每个节段的节段应变与梗死透壁程度之间存在明显的负相关关系（R = 0.67，p < 0.0001）。 结论 这项研究表明，再灌注治疗后 1.5 小时对局部和整体应变的评估与对比增强 MRI 确定的心肌梗死的大小和透壁程度相关。新的全局应变参数是总应变的一个有价值的预测因子。 心肌梗死的程度，因此可能是心肌梗死急性期风险分层的重要临床工具。
Objectives The objective of this study was to investigate whether strain Doppler echocardiography performed immediately after revascularization by percutaneous coronary intervention could predict the extent of myocardial scar, determined by contrast-enhanced magnetic resonance imaging (MRI).Background There is considerable variability in survival rate after percutaneous coronary intervention, and accurate early risk stratification is therefore of major clinical importance.Methods Thirty individuals with acute anterior myocardial infarction were examined with longitudinal strain by Doppler 1.5 h after revascularization. The extent of scarring 9 months later was analyzed by MRI in 16 corresponding myocardial segments. Strain in all left ventricular segments was averaged to obtain a global value. Infarct size was estimated by clinical parameters and cardiac markers.Methods Thirty individuals with acute anterior myocardial infarction were examined with longitudinal strain by Doppler 1.5 h after revascularization. The extent of scarring 9 months later was analyzed by MRI in 16 corresponding myocardial segments. Strain in all left ventricular segments was averaged to obtain a global value. Infarct size was estimated by clinical parameters and cardiac markers.Results A good correlation was found between the global strain and total infarct size (R = 0.77, p < 0.00001). A multivariate regression analysis showed that global peak strain and serum glutamic oxaloacetic transaminase correlated with the infarct size measured by MRI (p = 0.0001 and p = 0.001, respectively). Furthermore, a clear inverse relationship was found between the segmental strain and the transmural extent of infarction in each segment (R = 0.67, p < 0.0001).Conclusions This study demonstrates that assessment of regional and global strain at 1.5 h after reperfusion therapy correlates with size and transmural extent of myocardial infarction as determined by contrast-enhanced MRI The novel global strain parameter is a valuable predictor of the total extent of myocardial infarction and may therefore be an important clinical tool for risk stratification in the acute phase of myocardial infarction.