Assessment of Myocardial Ischemic Memory Using Three-Dimensional Speckle-Tracking Echocardiography: A Novel Integrated Analysis of Early Systolic Lengthening and Postsystolic Shortening
Assessment of Myocardial Ischemic Memory Using Three-Dimensional Speckle-Tracking Echocardiography: A Novel Integrated Analysis of Early Systolic Lengthening and Postsystolic Shortening
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DOI：
10.1016/j.echo.2019.06.013
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发表时间：
2019-11-01
影响因子：
6.5
通讯作者：
Nakatani, Satoshi
中科院分区：
文献类型：
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作者：
Kozuma, Ai;Asanuma, Toshihiko;Nakatani, Satoshi
背景资料：短暂性缺血后持续存在微小的异常心肌变形，如收缩后缩短（PSS），可用于诊断心肌缺血史（心肌缺血记忆）。此外，早期收缩期延长（ESL）最近引起了人们的注意，作为心肌缺血的另一个标志。然而，目前还不清楚是否可以检测到这种异常变形的持续性的三维（3D）斑点跟踪超声心动图，它具有相对较低的空间和时间分辨率相比，二维超声心动图。本研究的目的是评价三维斑点追踪超声心动图诊断心肌缺血记忆及其空间范围的准确性。方法：33只犬，结扎左回旋支2 min，然后再灌注。他们的血流动力学和三维超声心动图数据按时间顺序采集。分析左室各节段的收缩期峰值应变、收缩早期应变指数作为ESL的参数、收缩后应变指数作为PSS的参数以及心肌功能不全指数作为ESL和PSS的联合参数。在危险区的中心，收缩早期应变指数和收缩后应变指数与基线相比显著增加，直到再灌注后20 min，心肌功能不全指数在再灌注后20 min内显著升高，对缺血性记忆的诊断准确性高于其他指标。在147个危险节段中，49个节段（33%）在再灌注20 min时仍有心肌功能不全指数异常，而收缩期峰值应变异常的节段仅为13个（9%）。综合分析ESL和PSS对缺血性记忆的诊断准确率较高。这种方法可能是有用的，以检测短暂性缺血损伤的患者后，心绞痛发作消失。
Background: Persistence of subtle abnormal myocardial deformation such as postsystolic shortening (PSS) after transient ischemia can be used to diagnose a history of myocardial ischemia (myocardial ischemic memory). Furthermore, early systolic lengthening (ESL) has recently attracted attention as another marker of myocardial ischemia. However, it is unclear whether the persistence of such abnormal deformation can be detected by three-dimensional (3D) speckle-tracking echocardiography, which has relatively low spatial and temporal resolution compared with two-dimensional echocardiography. The aim of this study was to evaluate the diagnostic accuracy of myocardial ischemic memory and its spatial extent using 3D speckle-tracking echocardiography.Methods: The left circumflex coronary artery was occluded for 2 min, followed by reperfusion, in 33 dogs. Their hemodynamic and 3D echocardiographic data were chronologically acquired. Peak systolic strain, early systolic strain index as a parameter of ESL, postsystolic strain index as a parameter of PSS, and myocardial dysfunction index as a combined parameter of ESL and PSS were analyzed in all left ventricular segments.Results: At the center of the risk area, early systolic strain index and postsystolic strain index significantly increased until 20 min after reperfusion compared with baseline, although peak systolic strain recovered by 20 min. Myocardial dysfunction index significantly increased for >20 min after reperfusion and allowed better diagnostic accuracy of ischemic memory than the other parameters. In the 147 risk segments, abnormal values of myocardial dysfunction index remained in 49 segments (33%) at 20 min after reperfusion, whereas abnormal peak systolic strain was observed in only 13 segments (9%).Conclusions: ESL and PSS persisted after transient ischemia and could be detected by 3D speckle-tracking echocardiography. Integrated analysis of ESL and PSS provided higher diagnostic accuracy of ischemic memory. This method may be useful for detecting transient ischemic insults in patients after the disappearance of anginal attack.