在应激超声心动图左心房应变评估心肌缺血。

IF 0.7 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Eduardo Henrique Bonotto, Fernanda Arejano Vaucher, Miguel Morita Fernandes-Silva, Marco Stephan Lofrano-Alves
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引用次数: 0

摘要

简介:在缺血性级联中,舒张功能障碍先于心室收缩性改变。已知舒张期和收缩期左心室功能障碍通过损害左房心肌相功能来改变左房心肌变形,这可以使用斑点跟踪超声心动图进行评估。目的:评价左心房应变对多巴酚丁胺应激超声心动图检测心肌缺血的准确性。方法:前瞻性纳入疑似缺血行多巴酚丁胺应激超声心动图检查的患者。在多巴酚丁胺应激超声心动图的每个阶段分析左心房应变,包括它的三个组成部分-储层,导管和收缩。在多巴酚丁胺应激超声心动图中,心肌缺血的诊断定义为在至少两个连续的左心室段出现新的或恶化的壁运动异常。将多巴酚丁胺应激超声心动图显示为阳性的缺血患者与多巴酚丁胺应激超声心动图显示为阴性的缺血患者进行比较。结果:共纳入56例患者。诱导性缺血患者静息时和多巴酚丁胺应激超声心动图各期左房储层应变(LASr)值均显著降低,峰值应激时最低(27.6% (24.0 ~ 28.4)vs 34% (29.6 ~ 42.7), p < 0.001)。静息和低剂量多巴酚丁胺时LASr预测多巴酚丁胺应激超声心动图缺血(静息:曲线下面积= 0.68,p = 0.038;低剂量:曲线下面积= 0.78,p < 0.001)。峰值应力时LASr截断值为29.7%,对检测诱导性缺血具有较高的诊断准确性(曲线下面积= 0.88,p < 0.001)。结论:多巴酚丁胺应激超声心动图对疑似心肌缺血患者左心房应变的评估具有诊断价值,可与常规多巴酚丁胺应激超声心动图相结合,以证实阳性结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Left atrial strain during stress echocardiography for the assessment of myocardial ischaemia.

Introduction: Diastolic dysfunction precedes ventricular contractility changes in the ischaemic cascade. Both diastolic and systolic left ventricle dysfunctions are known to alter left atrial myocardial deformation by impairing its phasic function, which can be evaluated using speckle-tracking echocardiography.

Objective: The aim of this study was to assess the accuracy of left atrial strain in detecting myocardial ischaemia in patients undergoing dobutamine stress echocardiography.

Methods: Patients referred for dobutamine stress echocardiography due to suspected ischaemia were prospectively enrolled. Left atrial strain, including its three components - reservoir, conduit, and contractile - was analysed at each stage of dobutamine stress echocardiography. The diagnosis of myocardial ischaemia was defined as a new or worsening wall motion abnormality in at least two contiguous left ventricle segments during dobutamine stress echocardiography. Patients with a positive dobutamine stress echocardiography for ischaemia were compared with those with a negative dobutamine stress echocardiography for ischaemia.

Results: A total of 56 patients were included. Patients with inducible ischaemia had significantly lower left atrial reservoir strain (LASr) values at rest and throughout all dobutamine stress echocardiography phases, with the lowest values at peak stress (27.6% (24.0 to 28.4) vs 34% (29.6 to 42.7), p < 0.001). LASr at rest and during low-dose dobutamine predicted ischaemia during dobutamine stress echocardiography (rest: area under the curve = 0.68, p = 0.038; low dose: area under the curve = 0.78, p < 0.001). An LASr cutoff of ⩽29.7% at peak stress yielded high diagnostic accuracy in detecting inducible ischaemia (area under the curve = 0.88, p < 0.001).

Conclusion: Assessment of left atrial strain in patients undergoing dobutamine stress echocardiography for suspected myocardial ischaemia has diagnostic value and can be integrated into conventional dobutamine stress echocardiography to corroborate the findings of a positive test.

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来源期刊
Ultrasound
Ultrasound RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
CiteScore
1.70
自引率
0.00%
发文量
55
期刊介绍: Ultrasound is the official journal of the British Medical Ultrasound Society (BMUS), a multidisciplinary, charitable society comprising radiologists, obstetricians, sonographers, physicists and veterinarians amongst others.
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