应变显像评价ST段抬高急性心肌梗死患者存活心肌的敏感性与特异性

Sensitivity and specificity of strain imaging in evaluating myocardial viability among patients with ST-segment elevation acute myocardial infarction

目的比较应变显像（SI）与静息-再分布^201TI心肌灌注显像（RR^-201TI-SPECT）预测ST段抬高的急性心肌梗死（AMI）患者存活心肌的敏感性与特异性。方法对26例AMI患者进行介入治疗1周后行超声心动图和RR^-201TI-SPECT检查，并随访治疗≥3个月后的超声心动图。测量左室长轴16节段的应变及RR^-201TI-SPECT心肌灌注评分，以1周和≥3个月的室壁运动评分（WMS）对比作为判定存活心肌的“金标准”。结果①共研究260个缺血节段，随访（5±2）月，据WMS判定存活节段201个，梗死节段59个。RR^-201TI-SPECT预测存活心肌的敏感性和特异性为87％（175／201）和58％（34／59）。②以收缩期应变（Set）〈6％为最佳截止点预测存活心肌的敏感性和特异性分别为81％（161／201）和66％（39／59）。③Set与RR^-201TI-SPECT总符合率77％（199／260），具有中等一致性（Kappa=0．40）。结论SI评价ST段抬高AMI患者的存活心肌是可行的，其与RR^-201TI-SPECT显像诊断效力相似，是更简便、无创、低成本的替代选择。

Objective To compare the sensitivity and specificity of strain imaging （SI） and restredistribution TI^-201 （RR^-201 TI） SPECT imaging in evaluating myocardial viability among patients with ST elevation acute myocardial infarction（AMI）. Methods Twenty-six AMI patients underwent echocardiography and RR^-201 TI-SPECT imaging a week （baseline） after percutaneous coronary intervention（PCI） therapy. At baseline, wall motion score（WMS） and systolic strain were assessed,SPECT scoring were performed on 16 segments of left ventricle（LV）. WMS was repeated more than 3 months later to assess myocardial viability, which is deemed as reference. Results ①Two hundred and sixty segments in the ＂at risk＂ regions were followed up for （5 ±2） months,among which 201 were identified as viable and 59 were not,according to the WMS. ②In comparison to the reference standard,the sensitivity and specificity of RR^-201 TI-SPECT to predict myocardial viability were 87% （175/201） and 58% （34/59）respectively. ③he sensitivity and specificity of systolic strain （Set） to predict myocardial viability after AMI were 81% and 66% respectively at the optimal cut-off value of - 6%.④Set was moderately concordant with SPECT scoring（Kappa = 0.40） and the agreement between the two methods was 77% （199/260）. Conclusions In ST-elevation AMI,SI and RR^-201 TI-SPECT appears equivalent in predicting segmental recovery after reperfusion,and SI could be a convenient and low cost alternative for the nominvasive evaluation of myocardial viability