Role of strain values using automated function imaging on transthoracic echocardiography for the assessment of acute chest pain in emergency department
Role of strain values using automated function imaging on transthoracic echocardiography for the assessment of acute chest pain in emergency department
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DOI：
10.1007/s10554-015-0588-z
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发表时间：
2015-03-01
影响因子：
2.1
通讯作者：
Park, Seung Woo
中科院分区：
文献类型：
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作者：
Lee, Mirae;Chang, Sung-A;Park, Seung Woo
据报道，左心室应变超声心动图在检测心肌缺血方面比传统的经胸超声心动图（TTE）更敏感。我们评估了二维应变分析在急诊科（ED）评估急性胸痛的有效性。我们招募了以急性胸痛为急诊科症状的患者。排除st段抬高型心肌梗死、已知冠状动脉疾病（CAD）、非缺血性心肌病或非心源性胸痛患者。对所有患者进行CAD和TTEs的预测概率评估。其中包括区域壁面运动异常（RWMA）的视觉评估以及整体和区域纵向应变（GLS和RLS）的分析。回顾冠心病的诊断和急诊科就诊后1个月内心脏事件的发生情况。104例患者中有25%出现心脏事件，69例冠状动脉影像学检查中有36%发现冠心病。与RWMA相比，RLS对CAD具有更高的敏感性（敏感性/特异性= 64/89比92/ 77%）和相似的诊断准确性（79.7比82.6%,p = 0.791）。RLS也表现出比GLS（敏感性/特异性= 92/ 57%）或预诊概率（敏感性/特异性= 72/ 64%）更好的诊断性能。同样，RLS对1个月的心脏事件有较高的预测价值。在多变量分析中，包括预测概率、LVEF、RWMA、心脏酶、GLS和RLS；只有前测概率（OR 1.91, 95% CI 1.22-2.99, p = 0.005）和RLS （OR 25.42, 95% CI 1.84-342.04, p = 0.016）能独立预测CAD。应变超声心动图对急诊科急性胸痛患者的CAD诊断和未来事件预测具有较高的敏感性和阴性预测值。
Left ventricular strain echocardiography is reported to be more sensitive in detecting myocardial ischemia than conventional transthoracic echocardiography (TTE). We evaluated the usefulness of 2D strain analysis for the assessment of acute chest pain in emergency department (ED). Patients presenting to ED with acute chest pain were recruited. Patients with ST-elevation myocardial infarction, known coronary artery disease (CAD), non-ischemic cardiomyopathy, or non-cardiac chest pain were excluded. The pretest probability of CAD and TTEs were evaluated in all patients. TTEs included visual assessments of regional wall motion abnormality (RWMA) and analysis of global and regional longitudinal strain (GLS and RLS). The diagnosis of CAD and the occurrence of cardiac events during 1 month after ED visit were reviewed. Cardiac events were observed in 25 % of total 104 patients, and CAD was detected in 36 % of 69 patients with coronary imaging tests. Compared to RWMA, RLS showed higher sensitivity (sensitivity/specificity = 64/89 vs. 92/77 %) with similar diagnostic accuracy (79.7 vs. 82.6 %, p = 0.791) for CAD. RLS also demonstrated better diagnostic performance than either GLS (sensitivity/specificity = 92/57 %) or pretest probability (sensitivity/specificity = 72/64 %). Similarly, RLS had the higher predictive value for 1-month cardiac events. In multivariable analyses including pretest probability, LVEF, RWMA, cardiac enzyme, GLS, and RLS; only pretest probability (OR 1.91, 95 % CI 1.22-2.99, p = 0.005) and RLS (OR 25.42, 95 % CI 1.84-342.04, p = 0.016) independently predicted CAD. Strain echocardiography appears to be effective in diagnosing CAD and predicting future events with high sensitivity and negative predictive value in acute chest pain patients visiting ED.