Echocardiography is the imaging modality most frequently used to assess left ventricular ejection fraction(EF). However, the accuracy of the EF can be limited by the technical quality of the examination and observer v...Echocardiography is the imaging modality most frequently used to assess left ventricular ejection fraction(EF). However, the accuracy of the EF can be limited by the technical quality of the examination and observer variability. Recently, tissue Doppler was applied to acquire signals of myocardial systolic function, including systolic ejection velocity(Sa) and the systolic isovolumic acceleration rate(IVA). In that regard, IVA was reported in animal studies to be the ideal noninvasive index, because it was not affected by preload and afterload and provided a reliable assessment of contractility when examined against invasive gold standards. However, a paucity of data is available about its clinical application. We undertook this investigation to examine Sa and IVA in 40 normal subjects and 52 patients with depressed EF referred for echocardiographic examination, aiming to identify the signal with the highest reproducibility and the most accurate detection of depressed EF. Sa had the least inter- and intraobserver variabilities(3± 1.5% and 2.5± 1% , respectively), and IVA had the highest variability(8.1± 2.1% and 6.8± 2% , respectively). Although Sa and IVA were significantly lower in patients with depressed EF(p< 0.05), Sa had the best correlation with EF(r=0.65, p< 0.03) and Sa of< 7 cm/s was the most accurate(p< 0.05 vs IVA) in identifying patients with EF< 45% (sensitivity 93% , specificity 87% ). In conclusion, Sa velocity is the most suitable signal for clinical application as a surrogate for left ventricular EF, given its accuracy and reproducibility.展开更多
文摘背景：以前的血管内超声（intravascular ultrasound，IVUS）试验证实，他汀治疗可减缓或阻止动脉粥样硬化的进展，但是迄今尚无应用动脉粥样斑块体积百分比（percent atheroma volume，PAV）证实粥样硬化消退的确切证据。PAV是最严格的评价病变进展和消退的IVUS测量指标。
目标：评价极高强度他汀治疗是否能逆转IVUS确定的冠状动脉粥样硬化。
设计和地点：于美国、加拿大、欧洲和澳大利亚53个社区和3级保健中心进行前瞻性开标盲法终点试验（A Study to Evaluate the Effect of Rosuvastatin on Intravascular Ultrasound-Derived Coronary Atheroma Burden，ASTEROID）。应用马达驱动回撤IVUS评价基线和治疗24个月时冠状动脉粥样斑块负荷。每对基线和随访IVUS测量结果均进行盲法分析。
病例：从2002年11月到2003年10月，507例患者有基线IVUS检查结果，并接受至少1个剂量的研究药物。在24个月后，349例患者具有可用于评估的系列IVUS检查结果。
干预：所有患者均接受瑞舒伐他汀40ms／d强化治疗。
主要观测指标：预先设定了两个一级疗效指标：PAV变化和基线最严重病变10min节段动脉粥样斑块体积变化。二级疗效指标为整个动脉标准化总斑块体积的变化。结果：平均（SD）LDL—C水平由基线时的130．4（34．3）ms／dL降至60．8（20．0）ms／扎，平均下降了53．2％（P〈0．001）。平均（SD）HDL-C水平从基线时的43．1（11．1）ms／dL升至49．0（12．6）ms／dL，平均增加了14．7％（P〈0．001）。整个血管PAV平均（SD）变化为-0．98％（3．15％），中位数为-0．79％（97．5％CI，-1．21％～-0．53％）（与基线比较，P〈0．001）。最严重病变10min节段斑块体积平均（SD）变化为-6．1（10．1）mm^3，中位数为-5．6mm^3（97．5％CI，-6．8～-4．0mm^3）（与基线比较，P〈0．001）。总斑块体积变化中位数降低了6．8％，平均减少了-14．7（25．7）mm^3，中位数为-12．5mm^3（95％CI，-15．1～-10．5mm^3）（与基线比较，P〈0．001）。不良事件少见，与其他他汀试验相似。
结论：应用瑞舒伐他汀40ms／d进行极高强度他汀治疗可使LDL-C平均水平达到60．8ms／dL，使HDL—C增加14．7％。这导致所有3个预先设定的IVUS斑块负荷指标均显示动脉粥样硬化消退。因此，将LDL-C降至低于目前指南规定的水平，同时显著提高HDL-C，可以使冠心病患者动脉粥样硬化斑块消退。这些变化对临床预后的影响尚需进一步研究确定。
文摘Echocardiography is the imaging modality most frequently used to assess left ventricular ejection fraction(EF). However, the accuracy of the EF can be limited by the technical quality of the examination and observer variability. Recently, tissue Doppler was applied to acquire signals of myocardial systolic function, including systolic ejection velocity(Sa) and the systolic isovolumic acceleration rate(IVA). In that regard, IVA was reported in animal studies to be the ideal noninvasive index, because it was not affected by preload and afterload and provided a reliable assessment of contractility when examined against invasive gold standards. However, a paucity of data is available about its clinical application. We undertook this investigation to examine Sa and IVA in 40 normal subjects and 52 patients with depressed EF referred for echocardiographic examination, aiming to identify the signal with the highest reproducibility and the most accurate detection of depressed EF. Sa had the least inter- and intraobserver variabilities(3± 1.5% and 2.5± 1% , respectively), and IVA had the highest variability(8.1± 2.1% and 6.8± 2% , respectively). Although Sa and IVA were significantly lower in patients with depressed EF(p< 0.05), Sa had the best correlation with EF(r=0.65, p< 0.03) and Sa of< 7 cm/s was the most accurate(p< 0.05 vs IVA) in identifying patients with EF< 45% (sensitivity 93% , specificity 87% ). In conclusion, Sa velocity is the most suitable signal for clinical application as a surrogate for left ventricular EF, given its accuracy and reproducibility.
