Longitudinal and Circumferential Strain Rate, Left Ventricular Remodeling, and Prognosis After Myocardial Infarction
Longitudinal and Circumferential Strain Rate, Left Ventricular Remodeling, and Prognosis After Myocardial Infarction
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DOI：
10.1016/j.jacc.2010.06.044
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发表时间：
2010-11-23
影响因子：
24
通讯作者：
Solomon, Scott D.
中科院分区：
文献类型：
--
作者：
Hung, Chung-Lieh;Verma, Anil;Solomon, Scott D.
目的探讨高危心肌梗死（MI）后左心室纵向和周向应变（S）及应变率（SR）的临床预后价值。组织变形成像可能更密切地反映心肌收缩比传统措施的收缩functions.Methods的VALIANT（缬沙坦在急性心肌梗死试验）回波研究纳入603例左心室功能不全，心力衰竭，或两者5天后MI。我们用斑点追踪软件（Velocity Vector Imaging，Siemens，Inc.，山景，加州）。我们将整体S和SR与20个月随访时的LV重构和临床结局相关联。（平均值：-5.1 +/- 1.6 100/ms）和周向SR（平均值：-8.0 +/- 2.8 100/ms）预测死亡或因心力衰竭住院（风险比：2.4，95%置信区间[CI]：2.0至3.1，p < 0.001;风险比：1.3，95% CI：1.2至1.4，p < 0.001），在通过考克斯比例风险校正临床协变量后，在基于临床和标准超声心动图测量的模型上，纵向SR在预测18个月存活率方面进一步改善（受试者-操作者特征曲线下面积增加：0.13，p = 0.009）。多变量logistic回归分析显示，环向SR而非纵向SR对重塑有很强的预测作用（比值比：1.3，95% CI：结论纵向和周向SR均为MI后预后的独立预测因子，而仅周向SR可预测心肌重构，提示心肌梗死后保留的环周功能可能有助于抑制心室扩大。（J Am科尔心脏病学杂志2010;56：1812-22）（C）美国心脏病学会基金会2010年
Objectives We sought to investigate the clinical prognostic value of longitudinal and circumferential strain (S) and strain rate (SR) in patients after high-risk myocardial infarction (MI).Background Left ventricular (LV) contractile performance after MI is an important predictor of long-term outcome. Tissue deformation imaging might more closely reflect myocardial contractility than traditional measures of systolic functions.Methods The VALIANT (Valsartan in Acute Myocardial Infarction Trial) Echo study enrolled 603 patients with LV dysfunction, heart failure, or both 5 days after MI. We measured global peak longitudinal S and systolic SR (SRs) from apical 4- and 2-chamber views and global circumferential S and SRs from parasternal short-axis view with speckle tracking software (Velocity Vector Imaging, Siemens, Inc., Mountain View, California). We related global S and SRs to LV remodeling at 20-month follow-up and to clinical outcomes.Results Both longitudinal (mean: -5.1 +/- 1.6 100/ms) and circumferential SRs (mean: -8.0 +/- 2.8 100/ms) were predictive of death or hospital stay for heart failure (hazard ratio: 2.4, 95% confidence interval [CI]: 2.0 to 3.1, p < 0.001; hazard ratio: 1.3, 95% CI: 1.2 to 1.4, p < 0.001, respectively) after adjustment for clinical covariates by Cox proportional hazards, and longitudinal SRs further improved in predicting 18-month survivor on a model based on clinical and standard echocardiographic measures (increase in area under the receiver-operator characteristic curve: 0.13, p = 0.009). With multivariable logistic regression, circumferential SRs, but not longitudinal SRs, was strongly predictive of remodeling (odds ratio: 1.3, 95% CI: 1.1 to 1.4, p < 0.001).Conclusions Both longitudinal and circumferential SRs were independent predictors of outcomes after MI, whereas only circumferential SRs was predictive of remodeling, suggesting that preserved circumferential function might serve to restrain ventricular enlargement after MI. (J Am Coll Cardiol 2010;56:1812-22) (C) 2010 by the American College of Cardiology Foundation