二维斑点追踪超声心动图在评价急性心肌梗死后存活心肌及预测左心室重构中的价值  

Value of two-dimensional speckle-tracking echocardiography in accessing myocardial viability and predicting left ventricular remodeling after acute myocardial infarction

作　　者：王玮 赵航[1] 葛恒[1] 丁嵩[1] 沈学东[1] 卜军[1] WANG Wei;ZHAO Hang;GE Heng;DING Song;SHEN Xue-dong;PU Jun(Department of Cardiology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院心内科,上海200127

出　　处：《上海交通大学学报（医学版）》2018年第12期1447-1453,共7页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家重点研发计划(2016YFC1301203);上海申康医院发展中心课题(16CR3034A);上海交通大学医工交叉项目(YG2016MS45;YG2015ZD04)~~

摘　　要：目的·评价二维斑点追踪超声心动图(two-dimensional speckle tracking echocardiography,2D-STE)测量的应变参数在预测心脏节段功能恢复及左心室重构中的价值。方法·入选81名初发急性ST段抬高型心肌梗死患者。心脏磁共振成像检查于再灌注治疗后8 d内进行,测量指标包括坏死心肌百分比,以及是否存在心肌微循环障碍或心肌内出血。首次超声心动图检查与CMR检查同一天进行,2D-STE测量的指标包括节段及左心室整体心肌环周应变(circumferential strain,CS)、径向应变以及纵向应变。所有对象平均随访14个月后,再次行超声心动图检查。结果·与随访中未出现功能恢复的节段比较,出现功能恢复的节段基线时具有更高的应变参数绝对值。受试者工作特征(ROC)曲线分析结果显示,心肌梗死急性期CS≤-7.77%时预测节段功能恢复的敏感度和特异度最高,分别为77.17%和61.40%[曲线下面积(AUC)=0.74,P=0.000]。多因素Logistic回归显示,坏死心肌百分比,以及整体环周应变(GCS)是预测左心室重构的有力指标(均P<0.05)。ROC曲线分析结果显示,GCS≥-17.48%预测左心室重构的敏感度和特异度分别为83.33%和69.23%(AUC=0.80,P=0.000)。结论·在2D-STE的应变参数中,CS是预测心肌梗死后节段功能恢复和左心室重构的较为理想的指标。Objective · To evaluate the strain parameters measured by two-dimensional speckle tracking echocardiography(2 D-STE) in predicting myocardial segment functional recovery and left ventricular(LV) remodeling. Methods · Eighty-one patients with first acute ST-elevation myocardial infarction were enrolled. All patients underwent cardiac magnetic resonance(CMR) within 8 days after reperfusion therapy to detect the percentage of necrotic myocardium and the presence of microvascular obstruction or intra myocardial hemorrhage. Echocardiography examination for the first time was performed on the same day as CMR. Segmental and global circumferential strain(CS), radial strain, and longitudinal strain were measured by 2 D-STE.Echocardiography was performed again after an average follow-up of 14 months. Results · The segments with functional recovery were associated with higher absolute values of strain parameters at baseline compared to those without functional recovery. The receiver operating characteristic(ROC) curve analysis showed that the sensitivity and specificity of CS ≤-7.77% to predict the functional recovery of myocardial segment were 77.17% and 61.40%,respectively(AUC=0.74,P=0.000). Multiple Logistic regression showed that the percentage of necrotic myocardium and global CS(GCS) were the powerful predictors of LV remodeling(P<0.05). According to ROC curve analysis, GCS ≥-17.48% had sensitivity of 88.33% and specificity of 69.23%(AUC=0.80,P=0.000) in predicting LV remodeling. Conclusion · Among the strain parameters of 2 D-STE, CS may be an ideal predictor of segment functional recovery and LV remodeling after myocardial infarction.

关 键 词：二维斑点追踪超声心动图 急性心肌梗死 预后 左心室重构 心脏磁共振成像 

分 类 号：R540.45[医药卫生—心血管疾病] R543.3[医药卫生—内科学]