Клиническая практика (Apr 2024)
Information value of echocardiography in inferior myocardial infarction at different stages of observation
Abstract
BACKGROUND: A wide range of indicators and examination methods in acute myocardial infarction complicates their interpretation, affecting the objectivity and reliability of the final conclusions. In this situation, the results of a multivariate mathematical analysis can serve as a guide, allowing one to determine statistically significant indicators and establish a range of critical values for a particular case. AIM: to establish prognostically significant ranges of global and segmental deformation of the left ventricle using speckle tracking echocardiography in patients with acute inferior wall myocardial infarction of the left ventricle, who have undergone primary percutaneous coronary intervention, at the time of discharge from the hospital and in the long-term period. METHODS: Using speckle-tracking technology, the echocardiographic data were analyzed at the time of discharge and on the second year for 144 patients with acute inferior myocardial infarction of the left ventricle who underwent percutaneous coronary intervention. In the post-infarction period, 10 patients underwent magnetic resonance imaging and 15 patients underwent stress echocardiography. RESULTS: Using the tree construction method, the critical values of 7 ultrasound parameters were identified (for the left ventricle — ejection fraction, end-systolic volume index, global longitudinal and circular strains, for the right ventricle — tricuspid S’, global longitudinal strain, free wall strain), which predict a repeat revascularization with a probability of 89.4%. The identification of the possible areas of myocardial fibrosis in the remote period by speckle-tracking echocardiography has a sensitivity of 46–57%, specificity of 68–76%, and a negative predictive value of 74–87% relative to the gold standard detection of post infarction scarring by magnetic resonance imaging. According to the results of stress-echocardiography, new zones of local contractility impairment registered after exercises were not accompanied by changes in the segmental longitudinal deformation. CONCLUSION: The results of echocardiographic screening using speckle-tracking technology in patients with acute inferior myocardial infarction of the left ventricle have high prognostic significance in assessing the likelihood of repeated revascularization at the time of discharge and diagnostic information value for verifying post-infarction fibrous changes in the long-term period.
Keywords
