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Early prediction of myocardial viability after acute myocardial infarction by two-dimensional speckle tracking imaging

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Journal of Geriatric Cardiology 2015年第5期12卷 474-481页

作者： jong shin woo tae-kyung yu woo-shik kim kwon sam kim weon kim Division of Cardiology Department of lnternal Medicine Kyung Hee University Hospital Kyung Hee University Seoul South Korea

Background Identifying the transmural extent of myocardial necrosis and the degree of myocardial viability in acute myocardial infarction （AMI） is important clinically. The aim of this study was to assess myocardial viability using two-dimensional speckle tracking imaging （2D-STI） in patients with AMI. Methods 2D-STI was performed at initial presentation, three days, and six months after primary percutaneous coronary intervention （PCI） in 30 patients with AMI, who had a left anterior descending coronary artery （LAD） culprit lesion. In addition, 20 patients who had minimal stenotic lesions （〈 30% stenosis） on coronary angiography were also included in the control group. At six months dobutamine echocardiography was performed for viability assessment in seven segments of the LAD territory. According to the recovery of wall motion abnormality, segments were classified as viable or non-viable. Results A total of 131 segments were viable, and 44 were nonviable. Multivariate analysis revealed significant differences between the viable and nonviable segments in the peak systolic strain, the peak systolic strain rate at initial presentation, and peak systolic strain rate three days after primary PCI. Among these, the initial peak systolic strain rate had the highest predictive value for myocardial viability （hazard ratio： 31.22, P 〈 0.01）. Conclusions 2D-STI is feasible for assessing myocardial viability, and the peak systolic strain rate might be the most reliable predictor of myocardial viability in patients with AMI.

关键词： Acute myocardial infarction Two-dimensional speckle tracking imaging Viable myocardium

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Aortic arch calcification on chest X-ray combined with coronary calcium score show additional benefit for diagnosis and outcome in patients with angina

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Journal of Geriatric Cardiology 2016年第3期13卷 218-225页

作者： jong shin woo weon kim Se Hwan kwon Hyo Chul Youn Hyun Soo kim Jin Bae kim Soo Joong kim woo-shik kim kwon sam kim Cardiovascular Division Department of Internal Medicine Kyung Hee University Hospital Kyung Hee University Seoul South Korea Department of Radiology Kyung Hee University Hospital Kyung Hee University Seoul South Korea Department of Thoracic and Cardiovascular Surgery Kyung Hee University Hospital Kyung Hee University Seoul South Korea

Background The coronary artery calcium （CAC） and aortic arch calcification （AoAC） are individually associated with cardiovascular disease and outcome. This study investigated the predictive value of AoAC combined with CAC for cardiovascular diagnosis and outcome in patients with angina. Methods A total of 2018 stable angina patients who underwent chest X-ray and cardiac multi-detector computed tomography were followed up for four years to assess adverse events, which were categorized as cardiac death, stroke, myocardial infarction, or repeated revascularization. The extent of AoAC on chest X-ray was graded on a scale from 0 to 3. Results During the four years of fol- low-up, 620 patients were treated by coronary stenting and 153 （7%） adverse events occurred. A higher grade of AoAC was associated with a higher CAC score. Cox regression showed that the CAC score, but not AoAC, were associated with adverse events. In patients with CAC score 〈 400, AoAC showed an additive predictive value in detecting significant coronary artery disease （CAD）. A gradual increases in the risk of adverse events were noted if AoAC was present in patients with similar CAC score. Conclusions As AoAC is strongly correlated with the CAC score regardless of age or gender, careful evaluation of CAD would be required in patients with AoAC on conventional chest X-rays.

关键词： Aortic arch Atherosclerosis Calcification Coronary artery disease

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