Strain Echocardiography and Wall Motion Score Index Predicts Final Infarct Size in Patients With Non-ST-Segment-Elevation Myocardial Infarction
Strain Echocardiography and Wall Motion Score Index Predicts Final Infarct Size in Patients With Non-ST-Segment-Elevation Myocardial Infarction
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DOI：
10.1161/circimaging.109.910521
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发表时间：
2010-03-01
影响因子：
7.5
通讯作者：
Skulstad, Helge
中科院分区：
文献类型：
--
作者：
Eek, Christian;Grenne, Bjornar;Skulstad, Helge
背景-冠状动脉大小是心肌梗死后死亡率和主要不良心血管事件的强预测因子。急性再灌注治疗限制了梗死面积并提高了存活率，但其应用仅限于ST段抬高型心肌梗死患者。本研究的目的是评估非ST段抬高型心肌梗死患者血运重建前获得的左心室（LV）收缩功能超声心动图参数与最终梗死面积之间的关系，以及这些参数识别实质性梗死患者的能力。在血管重建前即刻，住院后2.1 ± 0.6天，通过超声心动图检查了抬高性心肌梗死。在16节段左心室模型中，通过射血分数、室壁运动评分指数以及周向、纵向和径向应变评估左心室收缩功能。整体应变表示平均节段应变值。在9 +/-3个月后，通过晚期增强MRI评估左室心肌体积占左室心肌总体积的百分比。心肌梗死面积与室壁运动积分指数（r = 0.74，P < 0.001）和整体纵向应变（r = 0.68，P < 0.001）相关。总体纵向应变>-13.8%和室壁运动评分指数>1.30准确识别实质性梗死患者（心肌>= 12%，n = 13;受试者工作曲线下面积分别为0.95和0.92）.结论：非ST段抬高型心肌梗死患者的左室收缩功能超声心动图参数与梗死面积相关。整体纵向应变和室壁运动评分指数都是识别实质性心肌梗死患者的极好参数，这些患者可能从紧急再灌注治疗中获益。(Circ血管造影。2010; 3：187-194.）
Background-Infarct size is a strong predictor of mortality and major adverse cardiovascular events after myocardial infarction. Acute reperfusion therapy limits infarct size and improves survival, but its use has been confined to patients with ST-segment-elevation myocardial infarction. The purpose of this study was to assess the relationship between echocardiographic parameters of left ventricular (LV) systolic function obtained before revascularization and final infarct size in patients with non-ST-segment-elevation myocardial infarction, as well as the ability of these parameters to identify patients with substantial infarction.Methods and Results-Sixty-one patients with non-ST-segment-elevation myocardial infarction were examined by echocardiography immediately before revascularization, 2.1 +/- 0.6 days after hospitalization. LV systolic function was assessed by ejection fraction, wall motion score index, and circumferential, longitudinal, and radial strain in a 16-segment LV model. Global strain represents average segmental strain values. Infarct size was assessed after 9 +/- 3 months by late-enhancement MRI, as a percentage of total LV myocardial volume. A good correlation was found between infarct size and wall motion score index (r = 0.74, P < 0.001) and global longitudinal strain (r = 0.68, P < 0.001). Global longitudinal strain >- 13.8% and wall motion score index >1.30 accurately identified patients with substantial infarction (>= 12% of myocardium, n = 13; area under the receiver operator curve, 0.95 and 0.92, respectively).Conclusions-Echocardiographic parameters of LV systolic function correlate to infarct size in patients with non-ST-segment-elevation myocardial infarction. Global longitudinal strain and wall motion score index are both excellent parameters to identify patients with substantial myocardial infarction, who may benefit from urgent reperfusion therapy. (Circ Cardiovasc Imaging. 2010; 3: 187-194.)