Assessing left ventricular systolic dysfunction after myocardial infarction: are ejection fraction and dP/dtmax complementary or redundant?
Assessing left ventricular systolic dysfunction after myocardial infarction: are ejection fraction and dP/dtmax complementary or redundant?
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DOI：
10.1152/ajpheart.01211.2011
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发表时间：
2012-04-01
影响因子：
4.8
通讯作者：
Hajjar, Roger J.
中科院分区：
文献类型：
--
作者：
Ishikawa, Kiyotake;Chemaly, Elie R.;Hajjar, Roger J.
石川K，Chemaly ER，Tilemann L，Fish K，Ladage D，Aguero J，Vahl T，Santos-Gallego C，Kawase Y，Hajjar RJ.评价心肌梗死后左室收缩功能障碍：射血分数和dP/dt（max）是互补还是冗余？Am J Physiol Heart Circ Physiol 302：H1423-H1428，2012。首次发表于2011年2月3日; doi：10.1152/ajpheart.01211.2011。在各种心脏收缩力参数中，左心室（LV）射血分数（EF）和最大dP/dt（dP/dt（max））是最简单和最常用的。然而，这些参数经常一起报告，不清楚它们是互补还是多余。我们试图比较EF和dP/dt（max）在评估猪心肌梗死（MI）后收缩功能障碍中的鉴别价值。共获得220个测量值。所有测量包括左心室容积和左心室造影、有创心室压力描记和超声心动图的EF分析。在132头猪中进行基线测量，并在MI创建后的不同时间点获得88个测量值。受试者操作特征曲线（ROC）用于区分MI的存在或不存在，显示EF具有良好的预测价值[曲线下面积（AUC）：0.998]，但dP/dt（max）没有预测价值（AUC：0.69，P < 0.001 vs. EF）。将dP/dt（max）除以LV舒张末期压和心率（HR）使AUC显著增加至0.87（P < 0.001 vs. dP/dt（max）和P < 0.001 vs. EF）。在未经处理的猪中，dP/dt（max）的变异系数是EF的两倍（分别为22.5%和9.5%）。此外，在n = 19只猪中，MI后dP/dt（max）增加。然而，对23头EF仅为36%~ 40%的猪进行的超声心动图应变分析显示，dP/dt（max）与非梗死区应变参数之间存在显著相关性（周向应变：r = 0.42，P = 0.05;径向应变：r = 0.71，P < 0.001）。总之，在猪MI模型中，EF是比dP/dt（max）更准确的收缩功能障碍指标。尽管dP/dt（max）在未处理猪和MI后均存在变异性，但它可敏感地反映心肌收缩力的微小变化。
Ishikawa K, Chemaly ER, Tilemann L, Fish K, Ladage D, Aguero J, Vahl T, Santos-Gallego C, Kawase Y, Hajjar RJ. Assessing left ventricular systolic dysfunction after myocardial infarction: are ejection fraction and dP/dt(max) complementary or redundant? Am J Physiol Heart Circ Physiol 302: H1423-H1428, 2012. First published February 3, 2011; doi: 10.1152/ajpheart.01211.2011.-Among the various cardiac contractility parameters, left ventricular (LV) ejection fraction (EF) and maximum dP/dt (dP/dt(max)) are the simplest and most used. However, these parameters are often reported together, and it is not clear if they are complementary or redundant. We sought to compare the discriminative value of EF and dP/dt(max) in assessing systolic dysfunction after myocardial infarction (MI) in swine. A total of 220 measurements were obtained. All measurements included LV volumes and EF analysis by left ventriculography, invasive ventricular pressure tracings, and echocardiography. Baseline measurements were performed in 132 pigs, and 88 measurements were obtained at different time points after MI creation. Receiver operator characteristic (ROC) curves to distinguish the presence or absence of an MI revealed a good predictive value for EF [area under the curve (AUC): 0.998] but not by dP/dt(max) (AUC: 0.69, P < 0.001 vs. EF). Dividing dP/dt(max) by LV end-diastolic pressure and heart rate (HR) significantly increased the AUC to 0.87 (P < 0.001 vs. dP/dt(max) and P < 0.001 vs. EF). In naive pigs, the coefficient of variation of dP/dt(max) was twice than that of EF (22.5% vs. 9.5%, respectively). Furthermore, in n = 19 pigs, dP/dt(max) increased after MI. However, echocardiographic strain analysis of 23 pigs with EF ranging only from 36% to 40% after MI revealed significant correlations between dP/dt(max) and strain parameters in the noninfarcted area (circumferential strain: r = 0.42, P = 0.05; radial strain: r = 0.71, P < 0.001). In conclusion, EF is a more accurate measure of systolic dysfunction than dP/dt(max) in a swine model of MI. Despite the variability of dP/dt(max) both in naive pigs and after MI, it may sensitively reflect the small changes of myocardial contractility.