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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。
Objective To investigate the early predictive value of strain rate imaging (SRI) on myocardial viability in patients with acute anterior ST-segment elevation myocardial infarction (STEMI). Methods SRI was measured postoperatively in patients with anterior wall STEMI who underwent emergency percutaneous coronary intervention (PCI). When the end-systolic strain (SES) ≥-7% was included in the study, After review, evaluate the predictive value of acute phase SRI on myocardial viability. RESULTS: Forty-six anterior STEMI patients were enrolled. Of these, 25 had SES <-6% at 6 months, defined as viable myocardium; 21 had SES ≥-7% at follow-up, and we defined as inactivated myocardium. The indexes of SES, SPS, SRS and SRE in surviving myocardium group were significantly better than those in inactivated myocardium group (P <0.01), and the rates of systolic strain, late diastole Strain rate was no significant difference between the two groups (P> 0.05). SRS, SRE, SPS and SES could predict myocardial viability. The area under the SRS curve was the largest (0.803, P <0.01). When the cutoff value was -0.31s-1, it predicted the sensitivity, specificity, The positive predictive value and negative predictive value were 83%, 68%, 76%, 71% respectively. Conclusions SRI can predict myocardial viability in the early stage of STEMI in patients undergoing emergency PCI.