Speckle tracking imaging in inflammatory heart diseases
Speckle tracking imaging in inflammatory heart diseases
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DOI：
10.1007/s10554-017-1284-y
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发表时间：
2018-05-01
影响因子：
2.1
通讯作者：
Copel, Laurian
中科院分区：
文献类型：
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作者：
Leitman, Marina;Vered, Zvi;Copel, Laurian
急性心肌炎的准确诊断对这些患者的预后和危险分层具有重要意义。心脏磁共振(CMR)已成为诊断心肌炎的主要手段，但尚未广泛应用。在这项研究中，我们试图通过斑点跟踪超声心动图评估急性炎症性心肌病患者的局部和整体纵向应变与CMR的相关性。前瞻性招募疑似急性心肌炎患者。临床诊断建立在临床、心电图、实验室和常规超声心动图数据的基础上。所有患者均行CMR，并在CMR后24小时内复查超声心动图。超声心动图检查采用斑点追踪成像软件进行离线分析。纳入32例急性心肌炎和肌包炎患者。平均年龄29+/-8岁，男性30例。所有患者均有胸痛和心电图异常，其中28例ST段抬高。肌钙蛋白升高30例，为0.7+/-0.5 ng/ml，肌酸激酶为487+/-319U，左心室射血分数为56+/-5%。室壁运动异常见于后外侧壁(53%)和下壁(21%)。29例患者CMR表现为延迟增强。基于斑点追踪成像的超声心动图EF与CMR计算的EF相关。区域应变幅度与延迟强化呈正相关，r=0.52。区域应变预测延迟强化的敏感性和特异性分别为85%和73%。斑点追踪成像可以帮助诊断急性心肌炎，当CMR不是很容易获得时。基于斑点跟踪成像的EF与CMR计算的LVEF和整体应变相关。
Accurate diagnosis of acute myocarditis is important for the prognosis and risk stratification of these patients. Cardiac magnetic resonance (CMR) has become a major modality for diagnosis of myocarditis, but not widely available. In this study, we tried to evaluate regional and global longitudinal strain by speckle tracking echocardiography in patients with acute inflammatory myocardial diseases in correlation with CMR. Patients with suspected acute myocarditis were recruited prospectively. Clinical diagnosis was established based on clinical, electrocardiographic, laboratory and conventional echocardiographic data. All patients underwent CMR and repeat echocardiographic examination within 24 h of CMR. Echocardiographic examinations were analyzed offline with speckle tracking imaging software. Thirty-two patients with acute perimyocarditis and myopericarditis were included. Mean age was 29 +/- 8, 30 males. All patients presented with chest pain and an abnormal electrocardiogram, in 28 ST elevation was found. Troponin was elevated in 30 and was 0.7 +/- 0.5 ng/ml. Creatine kinase was 487 +/- 319 U. LVEF was 56 +/- 5%. Wall motion abnormalities were present in postero-lateral (53%), and inferior wall (21%). Delayed enhancement on CMR was found in 29 patients. Echocardiographic EF based on speckle tracking imaging correlated with CMR calculated EF. There was a positive correlation between the amplitude of regional strain and delayed enhancement, r = 0.52. Sensitivity and specificity of regional strain for prediction of delayed enhancement was 85 and 73% respectively. Speckle tracking imaging can help in the diagnosis of acute myocarditis when CMR is not readily available. Speckle tracking imaging based EF correlates with CMR calculated LVEF and with global strain.