Impact of infarct transmurality on layer-specific impairment of myocardial function: a myocardial deformation imaging study
Impact of infarct transmurality on layer-specific impairment of myocardial function: a myocardial deformation imaging study
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DOI：
10.1093/eurheartj/ehp112
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发表时间：
2009-06-01
影响因子：
39.3
通讯作者：
Hoffmann, Rainer
中科院分区：
文献类型：
--
作者：
Becker, Michael;Ocklenburg, Christina;Hoffmann, Rainer
评价不同透壁性心肌梗死的内膜、中层心肌和心外膜心肌层的变形参数，并评估层特异性变形分析是否允许定义梗死透壁性。五十六例患者（平均年龄55 +/- 9岁，38例慢性缺血性左心室（LV）功能不全的男性）进行二维超声心动图和对比增强磁共振成像（ceMRI）。在16节段LV模型中，心肌梗死的程度通过ceMRI确定为相对增强量（0%，无梗死; 1- 50%，非透壁性梗死; 51- 100%，透壁性梗死）。在二维超声心动图胸骨旁短轴视图的基础上，使用声学超声心动图标记物（EchoPAC，GE Ultrasound）的自动逐帧跟踪系统，确定总壁厚和三个心肌层（内膜、中层心肌和心外膜）的峰值收缩期周向应变。在非透壁性梗死中，内膜层的周向应变损伤大于心外膜层，与对照节段相比，周向应变损伤相对减少，分别为45%和28%（P < 0.001）。在透壁性梗死中，心外膜层的周向应变损伤大于内膜层，与非透壁性梗死相比，周向应变损伤分别相对减少29%和7%（P < 0.001）。内皮层周向应变允许区分非透壁性与无梗死，其准确性高于总壁厚应变[曲线下面积（AUC）分别为0.842与0.774，P = 0.001]。心外膜层周向应变比总壁厚应变更能准确区分透壁性和非透壁性梗死（AUC分别为0.819和0.762，P = 0.005）。与对照组相比，透壁性梗死的两个层受到的影响相似。心肌变形的层特异性分析可以准确区分不同的透壁性心肌梗死类别。
To evaluate deformation parameters of an endocardial, mid-myocardial, and epicardial myocardial layer in different transmurality of myocardial infarction and assess whether layer-specific deformation analysis allows definition of infarct transmurality.Fifty-six patients (mean age 55 +/- 9 years, 38 men) with chronic ischaemic left ventricular (LV) dysfunction underwent two-dimensional echocardiography and contrast-enhanced magnetic resonance imaging (ceMRI). The extent of myocardial infarction was determined as relative amount of hyperenhancement by ceMRI in a 16-segment LV model (0%, no infarction; 1-50%, non-transmural infarction; 51-100%, transmural infarction). On the basis of two-dimensional echocardiographic parasternal short-axis views peak systolic circumferential strain was determined for the total wall thickness and for each of three myocardial layers (endocardial, mid-myocardial, and epicardial) using an automatic frame-by-frame tracking system of acoustic echocardiographic markers (EchoPAC, GE Ultrasound). In non-transmural infarction impairment of circumferential strain was greater in the endocardial than the epicardial layer, relative reduction compared with control segments, 45% vs. 28% (P < 0.001), respectively. In transmural infarction additional impairment of circumferential strain was greater in the epicardial than the endocardial layer, relative reduction compared with non-transmural infarction 29% vs. 7% (P < 0.001), respectively. Endocardial layer circumferential strain allowed distinction of non-transmural vs. no infarction with higher accuracy than total wall thickness strain [area under the curve (AUC) 0.842 vs. 0.774, respectively, P = 0.001]. Epicardial layer circumferential strain allowed distinction of transmural from non-transmural infarction with higher accuracy than total wall thickness strain (AUC 0.819 vs. 0.762, respectively, P = 0.005).Non-transmural infarction results in greater functional impairment of the endocardial than of the epicardial myocardial layer. In transmural infarction both layers are affected similarly compared with controls. A layer-specific analysis of myocardial deformation allows accurate discrimination between different transmurality categories of myocardial infarction.