Differentiation of subendocardial and transmural infarction using two-dimensional strain rate imaging to assess short-axis and long-axis myocardial function
Differentiation of subendocardial and transmural infarction using two-dimensional strain rate imaging to assess short-axis and long-axis myocardial function
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DOI：
10.1016/j.jacc.2006.07.050
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发表时间：
2006-11-21
影响因子：
24
通讯作者：
Marwick, Thomas H.
中科院分区：
文献类型：
--
作者：
Chan, Jonathan;Hanekom, Lizelle;Marwick, Thomas H.
本研究旨在通过二维应变（2D strain）评估左心室（LV）的短轴和长轴功能来区分透壁梗死范围（TME）。在80例慢性缺血性LV功能障碍患者（年龄63 ± 10岁）中进行。在短轴上使用峰值应变率（SR）和周向和径向应变（S）在心室中段水平评估心肌功能，在长轴上使用纵向SR和S评估心肌功能。DBE期间进行室壁运动分析以评估收缩储备。（-10.7 +/- 6.3）和SR（-1.0 +/-0.4）（S：-15.4 +/-7.0，p < 0.0001; SR：-1.4 +/-0.8，p = 0.02）和正常心肌（S：p < 0.0001; SR：p < 0.0001）。脑梗死段和内膜下梗死段的径向S和SR相似，内膜下梗死段的纵向S明显减少，（-13.2 +/- 5.6）和SR（-0.91 +/- 0.45）与正常心肌相比（S：-17.8 +/- 5.4，p < 0.0001; SR：-1.1 +/- 0.41，p < 0.0001），但内膜下和透壁梗死节段之间无显著差异（p = 0.09）。通过DBE进行的室壁运动分析不能识别CE-MRI上的内膜下梗死（TME 1%至50%，DBE瘢痕38%，DBE存活38%，DBE缺血24%，p = NS）。结论使用2D应变进行的长轴和短轴功能的联合评估可用于识别TME。
OBJECTIVES This study sought to differentiate the transmural extent of infarction (TME) by assessment of the short-axis and long-axis function of the left ventricle (LV) using 2-dimensional (2D) strain.BACKGROUND The differentiation of subendocardial infarction from transmural infarction has significant prognostic and clinical implications.METHODS Contrast-enhanced magnetic resonance imaging (CE-MRI) and dobutamine stress echocardiography (DBE) were performed in 80 patients (age 63 +/- 10 years) with chronic ischemic LV dysfunction. Myocardial function was assessed in the short axis at the midventricular level using peak strain rate (SR) and strain (S) in circumferential and radial dimensions, and was assessed in the long axis using longitudinal SR and S. Wall motion analysis was performed during DBE to assess for contractile reserve.RESULTS Transmural infarct segments had lower circumferential S (-10.7 +/- 6.3) and SR (-1.0 +/- 0.4) than subendocardial infarcts (S: -15.4 +/- 7.0, p < 0.0001; SR: -1.4 +/- 0.8, p = 0.02) and normal myocardium (S: p < 0.0001; SR: p < 0.0001). Transmural and subendocardial infarct segments had similar radial S and SR. Subendocardial infarct segments showed significant reduction of longitudinal S (-13.2 +/- 5.6) and SR (-0.91 +/- 0.45) compared with normal myocardium (S: -17.8 +/- 5.4, p < 0.0001; SR: -1.1 +/- 0.41, p < 0.0001), but there were no significant differences between subendocardial and transmural infarct segments (p = 0.09). Wall motion analysis by DBE could not identify subendocardial infarction on CE-MRI (TME 1% to 50% DBE scar 38%, DBE viable 38%, DBE ischemic 24%, p = NS).CONCLUSIONS The combined assessment of long-axis and short-axis function using 2D strain may be used to identify TME.