.< NGHlfeN COru LAM S A N G
MOI LIEN QUAN GlOfA StfC C A N G CO TIM VOfI CAC
T H O N G S6 CHIJfC NANG THAT TRAI TREN SIEU AM TIM 6 CAC BENH N H A N N H O I M A U COTIM CAP Dl/OfC CAN THIEP D O N G MACH V A N H .
N g u y i n Thj Thu Hoai', Nguyen Thj Thu Thuy*", Nguyen Quang Tuan", Nguyen Thj Bach Yen*, Oo Doan Ltfi**,Nguyen Lan Viet**,
*Vien Tim mach Viet Nam, Benh vien Tim Ha Npi.
" " Benh vien 198
T 6 M TAT
6 cac benh nhan nhoi mau ca tim (NMCT).
chuc nang that trai dong vai tro quan trong trong chi djnh cac phuong phap dieu tri, trong tien lugng benh va trong phan tang nguy co.
Phuotig phap danh gia svrc cSng ca tim (strain) va toe do cang ca tim (strain rate) giup danh gia do bidn dang cua co tim trong cac thai khoang tam thu va tara truang la mot phuang phap danh gia khach quan tinh trang van dpng vung thanh tim va chuc nang that trai.
Muc tieu: Tim hieu moi lien quan giua sue cang co tim voi vi tri NMCT, voi s6 lugng nhanh DMV bi ton thuang va tim hieu moi tucmg quan giua sue cang ca tim vai cac thong so chiic nang that trai tren sieu am Doppler tim.
Dfli tironog va phuwng phap nghien cmi:
Chung toi ti^n hanh nghien cuu tren 30 benh nhan NMCT cip lin dau co ST chenh len tai
Vien Tim mach Viet Nam, Benh vien Bach Mai tir thang 4/3013 dSn thang 10/2013. Tk ca cac benh nhdn deu dugc tham kham va lam cac xet nghiem sinh hoa, xet nghiem co ban va men tim theo benh an mau, lam dien t ^ do, sieu am Doppler mo ca tim. Sue cang co tim va toe do cang ca tim dugc danh gia bing phuang phap sieu am Doppler mo co tim. Tk ca cac benh nhan deu dugc chup DMV chgn lgc de danh gia muc do ton thuong DMV va dugc can thiep dgng mach vanh qua da. Sau can thiep DMV 2 ngay, 7 ngay, tat ca cac benh nhan deu dugc lam sieu am tim danh gia chuc nang tim bing phuang phap sieu am Doppler tim thuang quy va sieu am Doppler mo ca tim.
Ket qua: Cac benh nhan bi NMCT thanh truoc CO sue cang co tim thap hon so voi cac benh nhan NMCT thanh duoi a cac thai diem truac can thiep DMV, sau can thiep DMV hai ngay va sau can thiep bay ngay (p<0,01). S6 nhanh DMV bi ton thuang cang nhieu thi sue
70 I TAP CHl TIM MACH HOC VI$T NAM - S 6 65.2014
NGHIEN ClJfU LAM SANG ^ cang ca tim cang giam (p<0.01). Sue cang
ca tim CO tuang quan tuyen tinh chat che vai phan s6 t6ng mau thit trai (r = -0,61, p < 0,01), tuong quan tu>'en tinh muc do vira voi chi so van dgng vimg (r = 0,41, p < 0,05). Siic cang ca tim CO tuong quan tuyen tinh chat che voi kich thuac vung roi loan van dgng lien quan den 6 nhoi mau (r ^ 0,55, p < 0.05).
Ket luan: Sue cang co tim, mgt thong so danh gia su bien dang ca tim, do bang sieu am Doppler mo ca tim co moi lien quan chat che vcri vi tri NMCT, voi so lugng nhanh DMV bi ton thuang, co moi tuong quan tir vira den chat che vai cac thong so chuc nang tim, nen dugc ling dung trong lam sang de danh gia chiic nang that trai a cac benh nhan NMCT cap.
Danh gia siic cang co tim giiip phat hien scrm va khach quan nhirng bat thuona \i co gian cua \'ung c a tim. danh gia roi loan chijc nang \ u n g thanh tira trong XMCT. trong sieu am tim gang siic. danh gia kha nang sdng cua CO tim. phat hien scrm benh co lim. Day ]a mot phuang phap mai. khong dat tien. co th^ tj^
hanh nhieu lan tren cung rapt benh nhan...'-'.
0 Met Xam. chung toi chua lha\' co cong trinh nao nghien ciiu \ e siic cang c a tim a cac benh nhan NMCT cap. Chinh vi vay. chiing toiti^
hanh de tai nay vai muc tieu sau:
MUC TIEU
• 77m hieu moi lien quan giira sire cang CO' tim v&i vi triS.MCT va voi so litffng nhanh BMV bi ton thuong.
DATVANDE
Sieu am Doppler tira la mgt phuong p h ^ thuang quy dugc sii dung de danh gia chiic nang thit trai a cac benh nhan NMCT cip"-^-^"*. Cac thong so thuang dugc sii dung la phan s6 t6ng mau that trai (EF) va chi s6 van dgng viing thanh tim (CSVDT). Tuy nhien, cac thong so nay kha phu thugc vao kinh nghiem ciia bac si, va trong mgt s6 truang hgp, khong phai hoan toan khach quan. Sieu am tim danh gia siic cSng ca tim la mgt ky thuat tuong ddi mai co the lugng hoa su bidn dang cua ca tim trong thai ky tam thu va tam truang. Sue cang mo ta cac thay d6i tuong d6i vd chidu dai giira hai trang thai. Cho mgt vat vai chidu dai ban diu Lj, dugc keo dai hay nen lai dugc chidu dai moi la L, siic cang quy uoc dugc dinh nghta b3ng cong thiic Lagrangian'^-^-^^*^'">
L—Lo Trong do E: Sue cang : ~ ° L(,: Chieu dai ban diu
i o ^ 0 L: Chieu dai tiic thoi
^Nghien ciru moi tirong quan giira site ciing cff tim voi cdc t/tong so chirc nang that trdi tren sieu dm tint
DO! TUONG VA PHUCfNG PHAP
NGHIENCU'U: i
Doi tugng nghienciiu: 30 benh nhan duac chan doan la NMCT theo kliuydn cao ciia Hgi tim mach Chau Au nam 2012'-'. la NMCT lan dau CO ST chenh len. co chi dinh chup va can thiep DMV qua da tai Vien Tim Mach - Benh vien Bach Mai.
Tieu chudn loai trir: Chiing toi khong lay
\ao nghien cuu cac benh nhan co loan nhip
hoan toan vai bieu hien rung nliT tren dien tam
do (DTD), cac benh nhan c6 benh cip tinh-benh van tim nang. cac benh ngi khoa nang kem theo. benh co tim phi dai co tic nghen duong ra thit trai. benh nhan N M C T co bloc nhl thai do 2-3, benh nhan co bl6c nhanh tren DTD. dat may tao nhip. benh nhan co hinh anh sieu am m o kliong danh gia chinh xac dugc cac thong so sieu am. cac benh nhan klldng dong y tham gia vao nghien ciiu.
TAP CHl TIM .VACH HOC VIET NAM - SO 65.2014 I Tij
-< NCHIEN Ctfo IAM S,
PHUONG PHAP NGHIEN COU
Cac buoc tifa hanh nghien ciiu: Tk ca cac benh nhan dugc giai thich vS nghien ciiu va ky cam doan tham gia ngliien ciiu, duoc hoi benh, tham kham lam sang ky luOng va lam benh an theo mSu, lam mot s6 tham do va xet nghiem sinh hoa va men tim, chup X quang tim ph6i thjng, lam DTD 12 chuyto dao, lam sieu am Doppler tim. Tit ca cac benh nhan dSu dugc chup dgng mach vanh (DMV), nong va dat stent DMV va dugc theo doi danh gia lai kich thugc va chiic nang thit trai tren sieu toi Doppler tim sau 2 ngay va sau 7 ngay.
Quy trinh Iam sieu am Doppler tim: Dia diem: Tai phong sieu am tim, Vien Tim Mach- Benh vien Bach Mai. Chung toi su dung may sieu toi Alpha? do htog ALOKA sto xuat nam 2012 tai Nhat Bto voi dto do 3,5MHz co the thtoi do: SA tim TM, 2D, Doppler ximg, Doppler lien tuc, Doppler mau va Doppler mo
CO tim. Tren may co duong ghi dien tim dong thai vcri hinh anh sieu toi. Cac BN dSu dugc Itoi sieu toi theo quy trinh chuto cua Hgi sieu toi tim HoaKy'"•'".
Phuang phdp do sue cang ca tim (strain):
Chgn phto doan co tim cin khao sat, mSi thtoh tun do o 3 phto doan: vung day, vung giua va viing mom. Huong dg siic ctog chgn theo hugng tu day tgi mom, siic cang va toe dg ctog dugc hien thi bing phto mjm trong may sieu toi tim. Siic ctog ttoi thu (S): do tai thai diSm dinh siic ctog ttoi thu bing each dat con tr6 tai dinh duong cong siic cang ttoi thu (hinh 1). S the hien miic do bito dang cua phto doan co tim thi ttoi thu. Siic ctog mang diu (-), don vi tinh la %. S giam la benh ly.
Thuc hien cac phep do nay tren 18 phto doan tren 3 mat cit tit mom, nhung chi co 16 vCing dugc dung &k dtoh gia siic cang va CSVDT vi chiing toi loai di hai viing gin mom cua mat cit 3 bu6ng. Siic ctog toto phto dugc tinh la gia tri trung binh ciia 16 vung"*^.
Hinh I: Mmh hoa phuang phdp do siic cdng ca tim dinh tdm thu
72 I TAP CHl TIM MACH HOC VI$T NAM - S 6 65.2014
NGHIEN CUfU LAM SANIi
Phuong phap xir ly so lieu: Cac s6 lieu nghien ciiu dugc xu ly btog cac thuat toan thins t e \ hoc tren ma> \'i tinh bang phan mem STATA 10.0.
KET QUA NGHIEN CLfU
Dac dilm chung cua cac doi tugng nghien ciiii:
Trong thai gian tii thang 4 3013 din thang 10/2013, chirng toi tien hanh nghien ciru tren JO benh nhto NMCT cip co luoi tii 37 din 84. tuoi trung binh 61.8 ± 9.7. nam gioi chiSm 76,7%.
m
f
*
i
nu aiai chiem 23.3%.
1
fang 1 Dtjc diim \C- lam sdng i ci •^ic-ii tim ctia cac doi iiroiifi ngliien ciiu I Dac diem
s Nam "Nii
|]Tu6! (nam)
Chi so khoi CO Ihe (BMl-kg.'nvl
• Tan so tiin (lan phut) Huyet ap tam thu (mmHg) Huyei ap tam tnrimji(mmHg) Nong do dmh Troponin Tirong man Ing mil Thcri gian tir luc dau ngirc den khi can thiep (giol Tang huyet dp
Dai ihao ducnig ROI loan chu\en hoa lipid Hul thuoc la Tuoi 1 70
NMCT ihanh triroa NMCT thanh duoi NMCT kel hgp
Ton thuoiig dong mach (DM) lien thdt truoc DM vanli phai' DM mu'Than chung Ton thuang Inhanh DM\" 3 nhanh DMV }, nhanh DM\'
CSVDT
EF (piiiiongpbap Simpson) (°o) S'{cm si
E (cm -1 E (cm s)
SIIC cang cotim fSi loan phan ("D)
Gia trj trung binh hoac tyle % 23 7(76,7%'3.'^%) 61.8=9.7 22.61±2.65 8.v2=14.5 130,33±19.65 81.33±12,24 2 87=2.67 .^7,27±29,07 40%
26.7°o 33,3° 0 56.7%
23.3%
60% 30%'I0''o 76,7%/ 56,7%/ 33,3%/ 0%
50%/33.3%/16.7%
1.58=0 26 42.56±7.98 4.95=0,97 5,73=1,67 63,68 ±1,93 -7.44=2,40
,\7iOT? xil: Trong so benh nhto nghien cim thi t\ le nam/nCi = 3/1, NMCT thanh truoc chiem ti le cao nhat. roi den NMCT thtoh duoi. va d^n NMCT kk hop. Cac benh nhto tdn thuang DM jien that truoc (LTTr) chiem Iv le cao nhit. BM vanh phai va sau do din DM mu. Co 16.7% cac benh nhan bi ton thuang ca ba nhanh DMV Phto sd t6ne mau EF tmna binh cm cac bonh nhan la 42.56 = 7.98 (%). Sire cang ea lim toan phin trung binh la -7.44% ±2.40 (%!•
T..\P CHI TIM MACH HOC VIET NA.M - SO 65.2014 i ^ .
.^NGHIEN cOTu I A M SANG
Ket qua ve moi lien quan giira sire cang cff tim vffi vi tri NMCT va voi so lu-cmg nhanh DMV bj t5n thirffng.
Bang 2 Mdi lien quan giiia sue cdng cor tim \-di vt
Site cang cff tim theo vj tri NMCT
S (%) truac can thiep DMV
S (%) sau can thiep DMV hai ngay
S (%) sau can thiep DMV bay ngay
lri.S.\ICT
NMCT thanh tnrffc (n= 288 vung)
-7,09 ±2.31
-7,28 ±1,94
-7,35 = 2.18
NMCT thanh dirdi (n=144 vung)
-8.00 ± 2,04
-9,34 ±2,18
-9,30 ± 2,56
P
<0,01
<0,01
<0,01
(n = so viing thanh tim khao sat)
Nhdn xet: Co 16 benh nhto NMCT thtoh truoc vol s6 vimg ca tun dugc dtoh gia la 288 vimg, 9 benh nhto NMCT thtoh duoi vgi s6 vimg co tim dugc dtoh gia la 144 vimg. Ci ca thcii diSm trugc can thiep DMV va sau can thiep DMV 2 ngay, 7 ngay, nhom NMCT thtoh truoc co siic ctog CO tim trung bmh thip hon ro ret so vol nhom NMCT thtoh dual, su khac biet co y nghia thong ke d tat ca cac thoi diem nghito ciiu (p<0,01).
Bang 3. Mot lien quan giiia sue cdng ca tim vdi vi tri WICT Sirc cang ccr tim theo s&
n h i n h DMV bi ton thirong
S {%) tnroc can thiSp DMV
S (%) sau can thiep DMV hai ngay S (%) sau can thiep DMV bay
ngay
Ton thinmg 1 nhanh DMV (n=240 viing)
-8,27±2,52
-8,91=2.76
-9.00 = 2.56
Ton thirong 2 nhanh D M \ (n=l60^-ung)
-6,5 7± 1,67
-7,15±2.15
-6,99±1.98
Ton thirong 3 nhanh DMV
(n=80 ™ng)
-6,70±2,86
-6,78±2,57
-6,79±2,56
P
<0,01
<0,01
<0,01
(n = s6 viing thanh tim khao sat)
Nhdn xet: Co 15 benh nhto hi ton thuang 1 nhtoh DMV voi s6 vimg dugc dtoh gia la 240 vimg, CO 10 benh nhto ton thugng 2 nhtoh DMV vdi so vimg dugc dtoh gia la 160 vimg, cd 5 benh nhto tdn thuong 3 nhtoh DMV vdi sd vtag dugc dtoh gia la 80 vimg. Cd su khac biet v6 siic ctog CO tim giifa ba nhdm cd y nghia thong ke d tat ca cac thgi diem nghien ciiu (p<0.01).
Nhdm tdn thuang 3 nhtoh DMV cd sire ctog co tim thap nhat, sau do dto nhdm tdn thuang 2 nhtoh DMV rdi dto nhdm chi tdn thuong 1 nhtoh DMV.
74 I TAP CH( TLM MACH HOC VljT NAM - SO 65.2014
NGHIEN C t f U l A M S A ^ f i y l
Ket qua ve moi tirmig quan gi&a si^c cang cff tim v&i cac thong so chirc nang tim trin sieu am Doppler tim:
f -6»-
-1»J»-
^ ^ \
O 8 ^ " ^ °
'
Phan so t6ng mau thSt Irai
y = - 0,21 + 04>4 r = - 0,61 p < 0,001
. °
E F (%)
Hinh 2 Mdi luong quan giira sue cdng ca tim todn phdn v&i phdn sd tdng mdu EE
Nhtin xet: Co moi tuong quan tuySn tinh chat che giua sue cang ca tim loan phin vai p s6 l6ng mau EF vai r = - 0,61, p< 0,001
1.20 140 1 30 1 BO 2 00
Chi so TSiD floag vijng
Hmh 3 .Mdi tuang quan giua siic cdng ca tim todnphdn vat chi sd vdn dang viing thdnh ti
TAP CHI TIM MACH HOC VIjT NAM - SO 65.2014 |''S
' N G H I E N CCTU LAM SANG
Nhdn xet: Cd mdi tugng quan tuyin tinh mtic dg vira giira siic ctog ca tim tato phto vdi phto s6 tdng mau EF vai r = 0,41, p< 0,05.
-2i»-
•4 00-
-6 00-
10 00- o\o
«
0
i
o o
0 o o o
o o
1
j . " ' ^ o
^^"^
o^^•^o
8 '
y = 0,091-11,78 j r = 0,55
p < 0,05
:S.0O 30M 40O0 50J» €O0C 7C 00 BOW
Kich tfairtfc tiing nboi maa (°/o)
Hinh 4 Moi tuong quan gida sue cdng ca tim loan phdn vdi Idch ihuac viing nhdi mdu trin sieu dm tim
Nhdn xet: Kich thuac \ung nh6i mau duac tinh bang ty le phan tram giiia viing ca tim bi roi loan van dong tren toan bg so vung thanh tim cua benh nhan. Co moi tuang quan tuy^n tinh chat che giiJa sue cSng ca tim toan phan vcfi kich thuac vung NMCT tren sieu am tim vai r = 0,55, p<0,05.
BAN LUAN
Tu tnrcrc toi nay, cac phuang phap khong xam nhap co do chinh xac cao thuang dugc dung d^ danh gia tinh trang van dgng vimg thanh tim va chiic nang that trai o cac benh nhan bi benh DMV la phuang phap chup egng huong tir hat nhan (MRI). phuang phap xa hinh co tim (SPECT), sieu am tim can am.
Tu>' nhien, cac phuong phap nay doi hoi trang thidt bi d4t ti^n, khong dl dang thuc hien dugc tai giuong benh. Sieu am tim 2D la phuang phap cho phep danh gia kha chinh xac tinh trang van dgng vimg thanh tim va khong dat ti^n. nhung co nhuge diem la viec danh gia van dgng vung phu thugc kha nhieu vao kinh
nghiem ciia bac sT lam sieu am, doi hoi hinh anh sieu am phai ro net. Phuang phap sieu am Doppler mo ca tim cho phep do v ^ toe di chuyen cua mo ca tim trong thai ky tam thu va tam truang. \^ec danh gia siic cang ca tim bang phuang phap sieu am Doppler rao co tim giiip danh gia dugc dp co gian cua co tim. qua do lugng hoa dugc chiic nang vimg thanh tim, phat hien som nhiing thay doi ciia co bop ca tim. Vi siic cang ca tim dugc phan bo deu tren toan bg co tim nen viec phat hien mgt thay doi kin dao ciia siic cang co tim ciing giiip cho biet CO tinh trang roi loan chiic nang co bop viing thanh tim'* ^•"^•'2'. Trong nghien ciiu nav. chiing toi khao sat siic cang ciia timg vung thanh tim va siic cang toan phan ciia that trai cho 30 benh nhan NMCT cap lan dau dugc can thiep DMV. Ci cac benh nhan NMCT thanh truac, siic cang co tim thap han ro ret so voi cac benh nhan NMCT thanh duoi, su khac biet co y nghia thong ke vai p< 0,01. Siic cang co tim a cac benh nhan ton thuang nhieu nhanh dgng mach vanh thap hon so voi siic cang ca tim o cac benh nhan chi ton thuang mgt nhanh dgng mach \'anh, su khac biet co y nghia thong ke
76 I TAP CHi TIM MACH HOC V I £ T NAM - S 6 65.2014
NGHIEN CUfU LAM SANG*
vcri p<0,01. Bh giai thich di^u nay, chiing toi cho ihng cac benh nhan NMCT thanh truac CO pham vi ton thuang ca tim rgng han so voi cac benh nhan NMCT thanh duai nen chiic nang thit trai giam nhidu hon, siic cang co tim toan bg th4p hem so voi cac benh nhan NMCT thanh duoi. Cang nhiSu nhanh DMV bi ton thuang thi cang nhidu vimg co tim bi anh huong dhi ddn siic cang ca tira giam di. Tac gia Jamal F nghien ciiu bing sieu am Doppler mo CO tim d cac benh nhan NMCT cap cho thay stic cang co tim co gia tri han van toe mo CO tim trong vide phan biet nhiing vung ca tim v$n dgng bit thucmg vai nhirng viing co tim van dgng bmh thuang, giiip phat hien vimg lidn quan ddn 6 nhoi mau voi do nhay 85%''^'.
Trong nghidn ciiu cua chiing toi, siic cang CO tim CO moi tuang quan tuyen tinh chat che vai phan so tong mau EF {r ^-0,61), co m6i tucmg quan tuyen tinh miic do vira voi chi so van dgng vimg thanh tim (r = 0,41).
Ket qua nay ciing tucmg tu vai ket qua ctia tac gia Mistry N*'". Trong nghidn ciiu ciia tac gia Mistry N, siic cSng co tim co mdi tuang quan tuyen tinh miic do tir vira den chat che vai phan so tong mau do bang cac phuang phap egng huong tir hat nhan (r = 0,47), xa hinh CO tim SPECT (r = 0.52) va sieu am can am (r = 0,38)"". Tac gia Reisner nghien ciiu cac benh nhan NMCT ciing cho thdy siic cang CO tim CO moi tuong quan tuyen tinh vai chi so van dgng viing thanh tim vai r = 0,68"'".
Nghien ciiu ciia Palmieri cho thay mdi tuong quan nay co he s6 tuong quan r^ = 0,90"^'.
Nghien ciiu cua chiing toi cho thiy siic cang CO moi tuong quan vai kich thuac vimg co tim bi rdi loan van dgng do NMCT voi r = 0,55.
Kdt qua nay ciing phii hgp \ ai kdt qua ciia tac gia Mistry N'". Tac gia Sjoli B nghidn ctiu siic cang toan phin danh gia sau 10 ngay o 36 benh nhan NMCT co ST chdnh ldn dugc tai thong bang thudc tieu sgi huyet thay co
mdi tuang quan chat che \ a i kich thuoc vug;
nhdi mau do bang phuong phap cong huocg tir hat nhan'"''. Cac nghien ciiu tren th^ ojej cho thiy viec do miic do bien dang \i1n2 vj sure cang toan phan bang sieu am Dopplermo CO tim hay phuang phap danh dau mo co tun ddu CO gia tri tuong duang trong xac dinh kich thuac d nhoi mau, viing seo ciia CO tim. Gia Ui nguong cua cac nghien ciiu co the khac nhau.
didu nay dugc giai thfch bed kinh nghiem.
phuong phap nghien ciiu va su khac nhay trong thidt ke nghien ciiu''^'.
Hgn che ctia nghien ciru: Trong nghien Cliu nay, do sir dung phucmg phap sieu am Doppler md ca tim nen chiing toi chi khao sal dugc siic cang dgc co tim. Tren thuc te, trong qua trinh co bop, co tim bien dang theo ba chidu: chieu dgc. chieu ban kinh, va chieu chu vi. Ndu sii dung pliuong phap danh dau mo co tim 3D thi co the danh gia dugc siic cang co tim theo ca ba chieu nay. Tu>' nhien, theo giai phau CO tim, phan lan cac sgi co tim deu sap xep theo chieu dgc nen viec sii dung phuang phap sieu am Doppler md de danh gia siic cang dgc ca lim van dugc xem la mgt phucmg phap cd gia tri trong danh gia chirc nang viing CO tim'^-'-'.
KET LUAN
Siic cang ca tim. mgt thong sd danh gia su bidn dang ca tim. do bang sieu am Doppler md CO tim co moi lien quan chat che vai vi tri NMCT. vdi s6 lugng nhanh D M \ ' bi ton thucmg. Co moi tucmg quan tu}'en tinh tir vira ddn chat che giira siic cang co tim vai ca:
thdng so chuc nang tim.
Bi xudt: Nen iing dung siic cang ca tim trong lam sang de danh gia chiic nang that trai d cac benh nlian NMCT c i p .
TAP CHI TIM MACH HOC VIET NAM - SO 65.20141V
^NGHlfeN Ciifu LAM SANG
SUMMARY
RE LATIONBETWEEN TISSUE DOPPLERSTRAINANDECHOCARDIOGRAPHICLEFTVENTRICULAR FUNCTION IN PATIENTS WITH ACUTE MY0CARD1.\L INFARCTION TRE.ATED WITH PERCUTANOUS CORONARY INTERVENTION.
Nguyen Thi Thu Hoai, MD., PhD., Nguyen Thi Thu Thuy,MD., MSc., Nguyen Quang Tuan, MD., PhD., A/Prof. Nguyen Thi Bach Yen, MD., PhD.
A/Prof. Do Doan Loi, MD., PhD., Prof. Nguyen Lan VietJVID., PhD.
BACKGROUND:
The echocardiographic assessment of regional myocardial function plays a critical role in the diagnosis and management of patients with acute myocardial infarction and in most laboratories relies on the visual detecnon of endocardial wall motion abnormalities. However, this approach is subjective and operator dependent. Measurement ofmyocardial strain and stram rate are newer indices that have the potential to overcome these limitations.
AIMS:
To investigate: (1) The relation between longitudinal peak systolic strain - S(%) measured with tissue Doppler imaging (TDI) method and the infarct locations, the number of occluded/stenosed coronaiy artery. (2) The correlations between S(%) and echocardiographic ejection fraction (EF), wall motion score index (WMSI), and the infarct size.
METHODS: Thirty consecutive patients who presented with first acute myocardial infarction (AMI) were included in the study. All patients underwent successful percutaneous primary coronary intervention (pPCI). Standard and Tissue Doppler strain echocardiography was performed to all patients before pPCI and on day 2 and day 7.
RESULTS: Patients with antenor infarction had lower S(%) than patients with inferior infarction. S(%) in patients with multi-vessel disease were lower that that of patients with one-vessel disease. S(%) correlated strongly with EF (r = -0,61, p
<0,01) and correlated moderatedly with WMSI (r = 0,41, p <0,05). There was a strong correlation between S(%) and the infarct size (r = 0,55,p <0,05).
CONCLUSIONS: TDI strain is associated well with the infarct location, the number of diseased coronary artery, ejection fraction, wall motion score index, and the infarct size. TDI strain should be used in echocardiography practice for the assessment of left ventricular function in patients with AMI.
TAl UEU THAM KHAO
1. Do Doan Loi, Nguyen Lan Viet (2012). Sieu am Doppler tim. ATiaJTz/Afiaw Yhoc
2. Ph^m Nguyen Vinh, Phgm Gia Khai, Nguyin Lan \"iet, Dfl Doan Loi, Dinh Thu Huang, (2008), "Khuyen cao 2008 cua Hoi Tim mach hoc \'ief Nam ve ap dung lam sang sieu am tim", Khuyin cdo 2008 ve cdc benh ly Tim mgch vd chuyen hod, .\.\B Yhoc. tr. 556-571.
3. Nguyen Anh \'u (2010). "Sieu am tim c ^ nhat chan doan", Nhd xudt ban Dai hoc Hue
4. ESC Committee for Practice Guidelines (CPG) (2012) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation "The Task Force on the management of ST-segment elevation acute myocardial infarction of tlie European Society of Cardiology (ESC)" European HearlJournal; 33: 2569-2619.
5.Yasuhiko T., Patricia A. et al (2005), "Analysis of the interaction pattems and global diastole function b>' strain echocardioaraphy", American society of echocardiography published by Mosby. INC available online 7 September.
78 I TAP CHl TIM MACH HOC V I £ T NAM - S 6 65.2014
6.G»hrie\Yip{200:-')."Clm\calzpplicat\onofstrammekaaging\Jow7jaloflheAmericansocic^
16(12) pp. 1330-40.
T.Gregory Gihnan R.D^ Bijoy K., et al (2004), "Strain rate and strain: a step by step Approach to imaging andAh acquisition", .Z.-imfc/iocaralfpgr, 17, pp.1183-87.
g.Hooge D J . (2000), "Regional strain and strain rate measuments by cardiac ultrasound: principles implementioB^
limitation". £i/r J EcAocarrfiogropM-. pp. 154-170.
9. Sutheriand G.IL, Di Salvo G., Claus ?., et al (2004), "Strain and strain rate imaging: a new clinical apfmachfc quantify ing regional myocardial fimtion", J Am Soc Echocardogr, 17(7), pp. 788-802.
lO.^uichi Notomi, Maureen CMartin-Miklovic, Stephanie J , Oryszak, Takafairo Shiota (2006), "Eriaocd Ventricular Untwisting During Exercise: A Mechanistic Manifestation of Elastic Recoil Described by Doppl» Tisw Imaging". Circulatian; 113; 2524-2533.
ll.Mistry N. Beitnes J O . Halvor^n S, Abdelnoor M (2011). "Assessment of left ventricular function in ST-elevatia myocardial infarction by global longitudinal strain: a comparison with ejection fraction, infarct size, and wall motion scon index measured by non-invasive imaging modalities". European Journal of Echocardiography, 12. pp. 678-83
12. Brian D. Hoit (2011) "Strain and strain rate echocardiography and coronary artery disease". Circ CanSanac Imaging; A: 179-190.
13. Jamal F, Strotmann J , Weidemann F et al. (2001) "Noninvasive quantification of die contractile reserve of stunned myocardium by ultrasonic strain rate and strain". Circulation; 104: 1059 - 1065.
14. Rebner SA, Lysyansky P, Agmon \ , et al (2004) "Global longitudinal strain: A novel index of left ventiiciilBr systolic ftinction". J.4m Soc Echocardiogr, 17:630-3
15. Palmieri V. Russo C. Buonomo A. et al (2010) "Novel wall motion score-based method for estimating glob^
left ventricular ejection fraction: validation by real-time 3D echocardiography and global longitudinal strain". Eur J Echocardiogr, 11:125-30.
16.SjoIi B, Orn S, Grenne B, el al (2009) "Comparison of left ventricular ejection fraction and left ventricular global strain as deteiminants of infarct size in patients with acute myocardial infarction". J Am Soc Echocardiogr, 22: 1232-1
/ 7. Members of the Chamber Quantification fVriting Group: Roberto M. Lang, Michelle Bierig, Richard B. Devereux, Frank A. Flachsliampf, Elyse Foster, Patricia A. PelUklm, Michael H. Picard, Mary J. Roman, James Seward, JackS.
Shanewise, Scott D. Solomon. Kirk T. Spencer, MD, Martin Si John Sutton, and miUam J. Stewart "TlecommendaiiiB for Chamber Quantification: A Report from ttie American Socie^ of Echocardiogr^hy's Guidelines and Standaids Conmimec and the Chamber Quantification Writing Group, Developed in Conjunction with the European Associatioi of Echocardiography, a Branch of the European Society of Cardiology" J Am Soc Echocardiogr 2005:18:1440-1463 18. \ i c t o r Mor-Aii, Roberto .M. Lang, Luigi P. Badano, et al (2011) "Current and Evolving EchocaidiogrM*
Techniques for the Quantitative Evaluation of Cardiac Mechanics: ASE/EAE Consensus Statement on Methodol(^ nd Indications. Endorsed by the Japanese Society of Echocardiography" J.4m Soc Echocardiogr;2i:277-3n
