SRI对急性前壁STEMI患者心肌存活的早期预测价值

目的探讨应变率成像（SRI）对急性前壁ST段抬高心肌梗死（STEMI）患者心肌存活的早期预测价值。方法行急诊经皮冠状动脉介入术（PCI）的前壁STEMI患者在术后测量室间隔心尖段的SRI指标,当收缩末期应变（SES）≥-7%时则纳入研究,并于6个月后复查,评价急性期SRI指标对心肌存活的预测价值。结果 46例前壁STEMI患者纳入研究,其中25例在6个月时SES〈-7%,我们定义为存活心肌;21例随访时SES≥-7%,我们定义为失活心肌。存活心肌组SES、收缩后应变（SPS）、收缩期应变率（SRS）及舒张早期应变率（SRE）等指标明显优于失活心肌组（P〈0.01）,而收缩后应变率、舒张晚期应变率两组间无明显差异（P〉0.05）。SRS、SRE、SPS、SES均能预测心肌的存活,其中SRS曲线下面积最大（0.803,P〈0.01）,当临界值取-0.31s-1时,其预测存活心肌的敏感性、特异性、阳性预测值、阴性预测值分别为83%、68%、76%、71%。结论在行急诊PCI的前壁STEMI患者中,SRI技术能早期预测受累心肌的存活性。

Early prediction of myocardial viability by strain rate imaging in patients with anterior wall ST elevation myocardial infarction

Objective To investigate the predictive value of strain rate imaging（SRI） on myocardial viability in patients with anterior wall ST-elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PCI）. Methods SRI parameters of apical septal segments were determined in patients with anterior wall STEMI. The patients with their acute end-systolic strain values（SEs）≥-7% were included and reassess wall motion at 6-month followed-up. Results Forty-six anterior wall STEMI patients were enrolled. At the end of the followed-up, twenty-five segments improved their SEs to 〈-7% and were defined as viable, twenty-one failed to do so defined as non-viable. Compared to the non-viable group, viable segments had significantly better SEs, post-systolic strain, systolic and early diastolic strain rate values. All the above- mentioned parameters could predict myocardial viability in receiver operating characteristic curve analysis and systolic strain （SRs） had the largest area under the curve（0.803, P〈0.01）. With a cut-off value of-0.3Is-＇, SRS predicted viability with a sensitivity of 83%, specificity of 68%, positive predictive value of 76%, and negative predictive value of 71%. Conclusion SRI parameters appear to be promising predictors for myocardial viability in patients with acute anterior wall STEMI undergoing PCI.