臺灣博碩士論文加值系統

ABSTRACT
Aims
Recent years, strain and strain rate measurements has been introduced in estimation of left ventricular (LV) function and they are directly reflects myocardial deformation pattern. Current study was aimed to reveal long term prognostic relation of strain and strain rate parameters in patients after acute myocardial infarction (AMI).
Methods
We used prospective cohort study design in this study. A total of 542 patients after AMI were evaluated. 2 dimensional speckle tracking echocardiography was used to assess strain and strain rate parameters. Primary endpoint was all-cause mortality and secondary endpoint was a composite of re-infarction, revascularization and hospitalization for heart failure. Association between individual variables and study endpoints was assessed by univariable and multivariable Cox proportional hazard analysis.
Results
During follow-up, 58 patients (11%) reached primary endpoint and 184 patients (34%) reached secondary endpoint. Strain and strain rate both significantly associated with all endpoints. After adjustment of clinical and echocardiographic risk factors, global strain was independently associated with primary endpoint (hazard ratio 1.21, 95% CI 1.10-1.33) and secondary endpoint (hazard ratio 1.04, 95% CI 1.0-1.08) and determined to be superior to LV ejection fraction (LVEF) and wall motion score index (WMSI). Cox proportional hazard analysis demonstrated an increased risk for patients with global strain of ≥ -11.6% and global strain rate of ≥ -0.81 s-1 for all-cause mortality of 8.2 (95% CI 4.7-14.4%, P < 0.001) and 2.5 (95% CI 1.5-4.2, P < 0.01) times, respectively.
Conclusions
Global strain and strain rate parameters are independently and strongly associated with patient prognosis after AMI. For risk stratification after AMI, global strain and strain rate parameters were superior to LVEF and WMSI.
Keyword
Myocardial infarction, left ventricular function, strain and strain rate, patient prognosis

ABSTRACT
Aims
Recent years, strain and strain rate measurements has been introduced in estimation of left ventricular (LV) function and they are directly reflects myocardial deformation pattern. Current study was aimed to reveal long term prognostic relation of strain and strain rate parameters in patients after acute myocardial infarction (AMI).
Methods
We used prospective cohort study design in this study. A total of 542 patients after AMI were evaluated. 2 dimensional speckle tracking echocardiography was used to assess strain and strain rate parameters. Primary endpoint was all-cause mortality and secondary endpoint was a composite of re-infarction, revascularization and hospitalization for heart failure. Association between individual variables and study endpoints was assessed by univariable and multivariable Cox proportional hazard analysis.
Results
During follow-up, 58 patients (11%) reached primary endpoint and 184 patients (34%) reached secondary endpoint. Strain and strain rate both significantly associated with all endpoints. After adjustment of clinical and echocardiographic risk factors, global strain was independently associated with primary endpoint (hazard ratio 1.21, 95% CI 1.10-1.33) and secondary endpoint (hazard ratio 1.04, 95% CI 1.0-1.08) and determined to be superior to LV ejection fraction (LVEF) and wall motion score index (WMSI). Cox proportional hazard analysis demonstrated an increased risk for patients with global strain of ≥ -11.6% and global strain rate of ≥ -0.81 s-1 for all-cause mortality of 8.2 (95% CI 4.7-14.4%, P < 0.001) and 2.5 (95% CI 1.5-4.2, P < 0.01) times, respectively.
Conclusions
Global strain and strain rate parameters are independently and strongly associated with patient prognosis after AMI. For risk stratification after AMI, global strain and strain rate parameters were superior to LVEF and WMSI.
Keyword
Myocardial infarction, left ventricular function, strain and strain rate, patient prognosis

CONTENT
1. INTRODUCTION ……………………………………………………………………… 1
1.1. Background …………………………………………………………………………. 1
1.2. Aims of study ……………………………………………………………………….. 2
2. METHODS ……………………………………………………………………………… 3
2.1. Study Design ………………………………………………………………………... 3
2.2. Patient population …………………………………………………………………… 3
2.3. Selection of risk factors ……………………………………………………………... 3
2.4. Diagnosis of STEMI ……………………………………………………………....... 4
2.5. Definition of TIMI flow grade ……………………………………………………… 4
2.6. Echocardiography protocol …………………………………………………………. 5
2.7. Strain and strain rate measurement ………………………………………………… 6
2.8. Study endpoints ……………………………………………………………………... 7
2.9. Follow-up protocol ………………………………………………………………….. 7
2.10. Statistical analysis ………………………………………………………………….. 7
3. RESULTS ……………………………………………………………………………….. 9
3.1. Baseline characteristics ……………………………………………………………... 9
3.2. Follow-up …………………………………………………………………………… 9
3.3. Primary endpoint …………………………………………………………………... 10
3.4. Secondary endpoint ………………………………………………………………... 12
3.5. Kaplan-Meier survival analysis …………………………………………………… 13
4. DISCUSSION …………………………………………………………………………. 14
4.1. Summary of study …………………………………………………………………. 14
4.2. Risk stratification after AMI ………………………………………………………. 15
4.3. Importance of strain and strain rate in AMI ……………………………………….. 16
4.4. Clinical implication ………………………………………………………………... 18
5. CONCLUSION ………………………………………………………………............... 18
6. REFERENCE ………………………………………………………………................. 19
7. APPENDIX ………………………………………………………………..................... 29
8. ABBREVIATION ………………………………………………………………........... 29
9. TABLES AND FIGURES ……………………………………………………………. 32

REFERENCE
1. WHO. Fact sheet N317. http://www.who.int/mediacentre/factsheets/fs317/en/. updated January 2015, .
2. Mehta RH, Parsons L, Rao SV, Peterson ED. Association of bleeding and in-hospital mortality in black and white patients with ST-segmentelevation myocardial infarction receiving reperfusion. Circulation. 2012;125:1727–1734.
3. Fox KAA, Gabriel Steg P, Eagle KA, Goodman SG, Anderson FA, Granger CB, Flather MD, Budaj A, Quill A, Gore JM. Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006. JAMA. 2007;297:1892–1900.
4. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population trends in the incidence and outcomes of acute myocardial infarction. . N Engl J Med. 2010;362:2155–2165.
5. Mandelzweig L, Battler A, Boyko V, Bueno H, Danchin N, Filippatos G, Gitt A, Hasdai D, Hasin Y, Marrugat J, Van de Werf F, Wallentin L, Behar S. The second Euro Heart Survey on acute coronary syndromes: characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J. 2006;27:2285–2293.
6. Gabriel Steg P, James SK, Atar D, Badano LP, Lundqvist CB, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, Lenzen MJ, Mahaffey KW, Valgimigli M, van''t Hof A, Widimsky P, Zahger D, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P,
20
Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Hasdai D, Astin F, Astrom-Olsson K, Budaj A, Clemmensen P, Collet J-P, Fox KAA, Fuat A, Gustiene O, Hamm CW, Kala P, Lancellotti P, Maggioni AP, Merkely B, Neumann F-J, Piepoli MF, Van de Werf F, Verheugt F, Wallentin L. 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 the European Society of Cardiology. Eur Heart J. 2012;33(20):2569-2619.
7. Moller JE, Hillis GS, Oh JK, Reeder GS, Gersh BJ, Pellikka PA. Wall motion score index and ejection fraction for risk stratification after acute myocardial infarction. Am Heart J. 2006;151(2):419-425.
8. St John Sutton M, Pfeffer M, Plappert T, Rouleau J, Moye L, Dagenais G, Lamas G, Klein M, Sussex B, Goldman S. Quantitative two-dimensional echocardiographic measurements are major predictors of adverse cardiovascular events after acute myocardial infarction. The protective effects of captopril. . Circulation. 1994;84:68-75.
9. White H, Norris R, Brown M, Brandt P, Whitlock R, Wild C. Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation. 1987;76(1):44-51.
10. Nishimura RA, Reeder GS, Miller Jr FA, Ilstrup DM, Shub C, Seward JB, Tajik AJ. Prognostic value of predischarge 2-dimensional echocardiogram after acute myocardial infarction. Am J Cardiol. 1984;53(4):429-432.
11. O’Gara PT, Kushner FG, Ascheim DD, Casey Jr DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Kristin Newby L, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso JE, Tracy CM, Joseph Woo Y, Zhao DX. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation. 2013;127(4):529-555.
12. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, St John Sutton M, Stewart WJ. Recommendations for Chamber Quantification: A Report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440–1463.
13. Otterstad J, Froeland G, St John Sutton M, Holme I. Accuracy and reproducibility of biplane two-dimensional echocardiographic measurements of left ventricular dimensions and function. Eur Heart J. 1997;18(3):507-513.
14. Lieberman AN, Weiss JL, Jugdutt BI, Becker LC, Bulkley BH, Garrison JG, Hutchins GM, Kallman CA, Weisfeldt ML. Two-dimensional echocardiography and infarct size: relationship of regional wall motion and thickening to the extent of myocardial infarction in the dog. Circulation. 1981;63(4):739-738.
15. Abraham TP, Dimaano VL, Liang HY. Role of Tissue Doppler and Strain Echocardiography in Current Clinical Practice Circulation. 2007;116(22):2597-2609.
16. Reisner SA, Lysyansky P, Agmon Y, Mutlak D, Lessick J, Friedman Z. Global longitudinal strain: a novel index of left ventricular systolic function. J Am Soc Echocardiogr. 2004;17(6):630-633.
17. Biswas M, Sudhakar S, Nanda NC, Buckberg G, Pradhan M, Roomi AU, Gorissen W, Houle H. Two- and three-dimensional speckle tracking echocardiography: clinical applications and future directions. Echocardiography. 2013;30:88-105.
18. Skulstad H, Edvardsen T, Urheim S, Rabben SI, Stugaard M, Lyseggen E, Ihlen H, Smiseth OA. Postsystolic Shortening in Ischemic Myocardium: Active Contraction or Passive Recoil? Circulation. 2002;106:718-724
19. Biere L, Donal E, Terrien G, Kervio G, Willoteaux S, Furber A, Prunier F. Longitudinal strain is a marker of microvascular obstruction and infarct size in patients with acute ST-segment elevation myocardial infarction. PLoS One. 2014;9:e86959.
20. Sjoli B, Orn S, Grenne B, Ihlen H, Edvardsen T, Brunvand H. Diagnostic capability and reproducibility of strain by Doppler and by speckle tracking in patients with acute myocardial infarction. JACC Cardiovasc Imaging. 2009;2:24–33.
21. Zhang Y, Chan AKY, Yu C-M, Yip GWK, Fung JWH, Lam WWM, So NMC, Wang M, Wu EB, Wong JT, Sanderson JE. Strain rate imaging differentiates transmural from non-transmural myocardial infarction: a validation study using delayed-enhancement magnetic resonance imaging. J Am Coll Cardiol. 2005;46:864–871.
22. Grenne B, Eek C, Sjoli B, Dahlslett T, Hol PK, Orn S, Skulstad H, Smiseth OA, Edvardsen T, Brunvand H. Mean Strain Throughout the Heart Cycle by Longitudinal
Two-Dimensional Speckle-Tracking Echocardiography Enables Early Prediction of Infarct Size. J Am Soc Echocardiogr. 2011;24(10):1118-1125.
23. Altiok E, Tiemann S, Becker M, Koos R, Zwicker C, Schroeder J, Kraemer N, Schoth F, Adam D, Friedman Z, Marx N, Hoffmann R. Myocardial Deformation Imaging by Two-Dimensional Speckle-Tracking Echocardiography for Prediction of Global and Segmental Functional Changes after Acute Myocardial Infarction: A Comparison with Late Gadolinium Enhancement Cardiac Magnetic Resonance. J Am Soc Echocardiogr. 2014;27(3):249-257.
24. Bonios MJ, Kaladaridou A, Tasoulis A, Papadopoulou E, Pamboukas C, Ntalianis A, Kanakakis J, Terrovitis JV, Toumanidis ST. Value of apical circumferential strain in the early post-myocardial infarction period for prediction of left ventricular remodeling. Hellenic J Cardiol. 2014;55:305-312.
25. Katz JN, Stebbins AL, Alexander JH, Reynolds HR, Pieper KS, Ruzyllo W, Werdan K, Geppert A, Dzavik V, Van de Werf F, Hochman JS. Predictors of 30-day mortality in patients with refractory cardiogenic shock following acute myocardial infarction despite a patent infarct artery. Am Heart J. 2009;158:680–687.
26. Lee KL, Woodlief LH, Topol EJ, Douglas Weaver W, Betriu A, Col J, Simoons M, Aylward P, Van de Werf F, Califf RM. Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41,021 patients. GUSTO-I Investigators. Circulation. 1995;91:1659–1668.
27. Halkin A, Singh M, Nikolsky E, Grines CL, Tcheng JE, Garcia E, Cox DA, Turco M, Stuckey TD, Na Y, Lansky AJ, Gersh BJ, O’Neill WW, Mehran R, Stone GW. Prediction of Mortality After Primary Percutaneous Coronary Intervention for Acute
Myocardial Infarction: The CADILLAC Risk Score. J Am Coll Cardiol. 2005;45:1397–1405.
28. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. Third Universal Definition of Myocardial Infarction. Circulation. 2012;126:2020 –2035.
29. The TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) Trial — Phase I Findings. N Engl J Med. 1985;312:932-936.
30. The TIMI Study Group. Comparison of Invasive and Conservative Strategies after Treatment with Intravenous Tissue Plasminogen Activator in Acute Myocardial Infarction. N Engl J Med. 1989;320:618-627.
31. The GUSTO Angiographic Investigators. The effects of tissue plasminogen activator, streptokinase, or both on coronary artery patency, ventricular function, and survival after acute myocardial infarction. N Engl J Med. 1993;329:1615-1622.
32. The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med. 1993;329:673-682.
33. van de Werf F. Discrepancies between the effects of coronary reperfusion on survival and left ventricular function. Lancet. 1989;1:1367–1369.
34. Vogt A, von Essen R, Tebbe U, Feuerer W, Appel K-F, Neuhaus K-L. Impact of early perfusion status of the infarct-related artery on short-term mortality after thrombolysis for acute myocardial infarction: retrospective analysis of four German multicenter studies. J Am Coll Cardiol. 1993;21:1391-1395.
35. Anderson J, Karagounis L, Becker L, Sorensen S, Menlove R. TIMI perfusion grade 3 but not grade 2 results in improved outcome after thrombolysis for myocardial infarction: ventriculographic, enzymatic, and electrocardiographic evidence from the TEAM-3 study. Circulation. 1993;87:1829-1839.
36. Anderson J, Sorensen S, Moreno F, Hackworthy R, Browne K, Dale H, Leya F, Dangoisse V, Eckerson H, Marder V. Multicenter patency trial of intravenous anistreplase compared with streptokinase in acute myocardial infarction. Circulation. 1991;83:126-140.
37. Karagounis L, Sorensen SG, Menlove RL, Moreno F, Anderson JL. Does Thrombolysis in Myocardial Infarction (TIMI) perfusion grade 2 represent a mostly patent artery or a mostly occluded artery? Enzymatic and electrocardiographic evidence from the TEAM-2 study. J Am Coll Cardiol. 1992;19:1-10.
38. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16(7):777-802.
39. Naqvi TZ, Padmanabhan S, Rafii F, Hyuhn HK, Mirocha J. Comparison of usefulness of left ventricular diastolic versus systolic function as a predictor of outcome following primary percutaneous coronary angioplasty for acute myocardial infarction. Am J Cardiol. 2006;97(2):160-166.
40. Leitman M, Lysyansky P, Sidenko S, Shir V, Peleg E, Binenbaum M, Kaluski E, Krakover R, Vered Z. Two-dimensional strain - a novel software for real-time
quantitative echocardiographic assessment of myocardial function. J Am Soc Echocardiogr. 2004;17(10):1021-1029.
41. Geleijnse ML, Fioretti PM, Roelandt JRTC. Methodology, Feasibility, Safety and Diagnostic Accuracy of Dobutamine Stress Echocardiography. J Am Coll Cardiol. 1997;30:595–606.
42. Hicks KA, Tcheng JE, Bozkurt B, Chaitman BR, Cutlip DE, Farb A, Fonarow GC, Jacobs JP, Jaff MR, Lichtman JH, Limacher MC, Mahaffey KW, Mehran R, Nissen SE, Smith EE, Targum SL. 2014 ACC/AHA Key Data Elements and Definitions for Cardiovascular Endpoint Events in Clinical Trials. JACC. 2015;131:000–000.
43. Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J. 2000;21(18):1502–1513.
44. McManus DD, Gore J, Yarzebski J, Spencer F, Lessard D, Goldberg RJ. Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Am J Med. 2011;124:40-47.
45. Roe MT, Messenger JC, Weintraub WS, Cannon CP, Fonarow GC, Dai D, Chen AY, Klein LW, Masoudi FA, McKay C, Hewitt K, Brindis RG, Peterson ED, Rumsfeld JS. Treatments, trends, and outcomes of acute myocardial infarction and percutaneous coronary intervention. J Am Coll Cardiol. 2010;56:254–263.
46. Jernberg T, Johanson P, Held C, Svennblad B, Lindback J, Wallentin L. Association between adoption of evidence-based treatment and survival for patients with ST-elevation myocardial infarction. JAMA. 2011;305:1677– 1684.
27
47. Edvardsen T, Gerber BL, Garot J, Bluemke DA, Lima JAC, Smiseth OA. Quantitative Assessment of Intrinsic Regional Myocardial Deformation by Doppler Strain Rate Echocardiography in Humans. Circulation. 2002;106:50-56.
48. Haberka M, Liszka J, Kozyra A, Finik M, Gąsior Z. Two-dimensional speckle tracking echocardiography prognostic parameters in patients after acute myocardial infarction. Echocardiography. 2015;32:454-460.
49. Lacalzada J, de la Rosa A, Izquierdo M, Jimenez J, Iribarren J, Garcia-Gonzalez M, Lopez B, Duque M, Barragan A, Hernandez C, Carrillo-Perez M, Laynez I. Left ventricular global longitudinal systolic strain predicts adverse remodeling and subsequent cardiac events in patients with acute myocardial infarction treated with primary percutaneous coronary intervention. Int J Cardiovasc Imaging. 2015;31:575-584.
50. Bjork CI, Rozis E, Slordahl SA, Marwick TH. Incremental Value of Strain Rate Imaging to Wall Motion Analysis for Prediction of Outcome in Patients Undergoing Dobutamine Stress Echocardiography Circulation. 2007;115:1252–1259.
51. Antoni LM, Mollema SA, Delgado V, Atary JZ, Jan Willem Borleffs C, Boersma E, Holman ER, Van der Wall EE, Schalij MJ, Bax JJ. Prognostic importance of strain and strain rate after acute myocardial infarction. Eur Heart J. 2010;31(13):1640-1647.
52. Antoni ML, Scherptong RW, Atary JZ, Boersma E, Holman ER, van der Wall EE, Schalij MJ, Bax JJ. Prognostic value of right ventricular function in patients after acute myocardial infarction treated with primary percutaneous coronary intervention. Circ Cardiovasc Imaging. 2010;3:264-271.
53. Antoni ML, ten Brinke EA, Atary JZ, Marsan NA, Holman ER, Schalij MJ, Bax JJ, Delgado V. Left atrial strain is related to adverse events in patients after acute myocardial infarction treated with primary percutaneous coronary intervention. Heart. 2011;97:1332-1337.