异舒吉超声心动图试验预测老年急性心肌梗死患者室壁运动异常节段自发改善的研究

The predicting value of isoket echocardiography for spontaneous functional improvement of dyssynergic segments in old patients with acute myocardial infarction

目的 观察老年急性心肌梗死 (AMI)患者运动异常节段功能的自发性改善 ,评价异舒吉二维超声心动图(2DE)试验的预测价值和安全性。方法 发病 2～ 10h后入院的AMI患者 17例 ,男 16例 ,女 1例 ,平均年龄 6 0岁。于梗死后 7～ 14(10± 3)d行异舒吉 2DE试验 ,6个月左右 (16 3d)行 2DE复查。用 16 节段半定量分析法对左室各节段收缩运动和增厚情况给予分级记分。依据随诊时运动异常节段收缩功能的改善情况 ,计算异舒吉 2DE试验预测AMI运动异常节段收缩功能自发改善的准确性 ,并评价其安全性。结果 17例首次AMI患者 134个异常节段中 ,2DE试验时检出 42 (31.3% )个存活心肌节段 ,随诊时有 5 1个节段 (38.1% )收缩功能自发改善。因此 ,异舒吉 2DE试验识别存活心肌并预测其自发改善的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 6 6 .7%、90 .4%、81.0 %、81.5 %和 81.3% ;而且对运动减低节段预测的敏感性和阳性预测值均显著高于无运动节段 (6 9.6 %和 86 .5 % ,40 %和 40 % ,P均 <0 .0 5 ) ;未出现明显的副作用。结论 老年AMI患者异常节段中约 38.1%可发生功能自发性改善 ,异舒吉 2DE试验对此有较准确的预测价值 ,且很安全。

Objective To observe spontaneous functional improvement of dyssynergic segments in old patients with acute myocardial infarction (AMI) and evaluate the predicting value of isoket-two-dimensional echocardiography (2DE) for the improvement. Methods In 17 old patients (mean age of 60 years) with first AMI,regional wall motion abnormality (RWMA) was evaluated at baseline.Isoket 2DE test was conducted on days 7～14 (the mean of 10±3) after the infarction and at 6 month (the mean of 163 days) follow-up.Left ventricular regional wall motion and thickening in each segment were graded and scored using a 16-segment model and semiquantitative analysis method.The viable myocardial segments detected were compared with the actual spontaneous functional improvement of corresponding segments to calculate the sensitivity,specificity,positive and negative predicting value (PPV and NPV) and accuracy of the test in predicting functional spontaneous improvement.Results Of 134 dyssynergic segments in 17 old patients with AMI,42(31.3%) segments in the isoket-2DE test showed reversible dyssynergy,and 51segments (38.1%) showed spontaneous functional improvement at 6 month follow-up.Therefore,the sensitivity,specificity,PPV,NPV and accuracy of the isoket-2DE test for identifying viable myocardium and predicting functional improvement in patients with AMI were 66.7%,90.4%,81.0%,81.5% and 81.3%,respectively;and the sensitivity and PPV in hypokinetic segments were higher than those in akinetic segments(69.6% and 86.5% vs 40% and 40%,both P<0.05).There was no side effects during isoket-2DE test.Conclusions The spontaneous functional improvement can happen in 38.1% of dyssynergic segments in old patients with first AMI,and isoket-2DE test can relatively accurately predict the improvement without side effects.