medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2024-14-33-42medalphabet-3810Research ArticleСтатьиЗначение спекл-трекинг эхокардиографии с оценкой миокардиальной работы левого желудочка в прогнозировании поражения коронарных артерий при остром коронарном синдроме без подъема сегмента STPotential of speckle tracking echocardiography with the assessment of left ventricle myocardial work in predicting coronary artery disease in non-ST-segment elevation acute coronary syndromehttps://orcid.org/0000-0001-9941-8885ТюринаЛ. Г.TyurinaL. G.

Тюрина Ляля Георгиевна - врач отделения ультразвуковой диагностики.

Москва

Tyurina Lyalya G. - physician of the Diagnostic Ultrasonography Dept.

Moscow

tyurina.lyalya@mail.ruhttps://orcid.org/0000-0002-9669-9164ХамидоваЛ. Т.KhamidovaL. T.

Хамидова Лайлаъ Тимарбековна - д. м. н. руководитель отдела лучевой диагностики.

Москва

Khamidova Layla T. - DM Sci (habil.), head of the Scientific Dept of Diagnostic Radiology.

Moscow

layla72@mail.ruhttps://orcid.org/0000-0001-6973-4430РыбалкоН. В.RyubalkoN. V.

Рыбалко Наталья Владимировна - д. м. н. ведущий научный сотрудник отделения ультразвуковой и функциональной диагностики. ID РИНЦ – 507463.

Москва

Rybalko Natalia V. - DM Sci (habil.), leading researcher of the Ultrasound and Functional Diagnostics Dep. RSCI ID: 507463–507463.

Moscow

rybalko_dr@mail.ruhttps://orcid.org/0009-0003-3989-9033КолташоваС. А.KoltashovaS. A.

Колташова Светлана Анатольевна - врач отделения функциональной диагностики2.

Екатеринбург

Koltashova Svetlana A. - physician of the Functional Diagnostics Dept.

Ekaterinburg

sak2505@yandex.ruhttps://orcid.org/0000-0002-8980-4931КислухинаЕ. В.KislukhinaE. V.

Кислухина Евгения Викторовна - старший научный сотрудник лаборатории АСУ лечебно-диагностическим процессом.

Москва

Kislukhina Evgenia V. - senior researcher at the Laboratory of Automated Control Systems for diagnostic and treatment processes.

Moscow

KislukhinaEV@sklif.mos.ruhttps://orcid.org/0000-0001-5090-6212ГазарянГ. А.GazaryanG. A.

Газарян Георгий Арташесович - д. м. н., проф., зав. отделением неотложной кардиологии с методами неинвазивной функциональной диагностики.

Москва

Gazaryan George A. - DM Sci (habil.), professor, head of Dept of Urgent Clinical Cardiology with Non-invasive Functional Diagnostic Techniques.

Moscow

gigls@mail.ruГБУЗ г. Москвы «Научно-исследовательский институт скорой помощи имени Н.В. Склифосовского Департамента здравоохранения Москвы»РоссияN.V. Sklifosovsky Research Institute for Emergency MedicineRussian FederationМедицинский центр «Novi»РоссияMedical Center NoviRussian Federation202411082024014Кардиология. Неотложная медицина (2)3342Copyright © Тюрина Л.Г., Хамидова Л.Т., Рыбалко Н.В., Колташова С.А., Кислухина Е.В., Газарян Г.А., 20242024Тюрина Л.Г., Хамидова Л.Т., Рыбалко Н.В., Колташова С.А., Кислухина Е.В., Газарян Г.А.Tyurina L.G., Khamidova L.T., Ryubalko N.V., Koltashova S.A., Kislukhina E.V., Gazaryan G.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/3810Цель

Цель. Оценить значения параметров продольной деформации и миокардиальной работы левого желудочка (ЛЖ) при остром коронарном синдроме без подъема сегмента ST (ОКСбпST) в прогнозировании поражения коронарных артерий (КА), определении показаний к ранней инвазивной диагностике и лечению.

Материалы и методы

Материалы и методы. В исследование включен 51 больной, госпитализированный в отделение интенсивной терапии института с диагнозом ОКСбпST в возрасте от 41 до 93 лет. При поступлении оценивался риск госпитальной летальности по GRACE, выполнялась стандартная и спеклтрекинг эхокардиография (СТ ЭхоКГ) с определением параметров продольной деформации и миокардиальной работы ЛЖ, проводилась коронарография (КАГ) в сроки от 12 до 48 часов. Группу сравнения составили 20 человек без ишемической болезни сердца (ИБС).

Результаты

Результаты. При оценке степени риска по GRACE больные с низким и средним риском составили 41 и 47 %. Нарушения локальной сократимости при стандартной ЭхоКГ были выявлены у 15 больных (29 %). При анализе региональных параметров продольной деформации и миокардиальной работы наибольшую ценность в выявлении поражения коронарных артерий (КА) продемонстрировала зона функционального риска из 4 и более смежных сегментов ЛЖ с индексом работы миокарда ≤1400 мм рт. ст. х% (чувствительность и специфичность 84,2 % и 78,1 %, AUC=0,83). Практически у всех пациентов в дисфункциональных сегментах зоны риска определялся парадоксальный механизм деформации в виде постсистолического укорочения с постсистолическим индексом, достигающим значения ≥20 %. Сочетание значимого повышения ПСИ и ЗФР, ограничиваемой даже 3 сегментами, свидетельствовало oб остроте коронарной недостаточности, гемодинамически значимом стенозе (чувствительность и специфичность 84 и 79 %). При распределении пациентов с учетом данных стандартной и СТ ЭхоКГ с оценкой миокардиальной работы в отсутствие достоверных нарушений систолической функции превалировали больные с интактными или незначимыми изменениями в основных КА; среди пациентов без визуальных нарушений сократимости выявленная ЗФР при оценке индекса работы миокарда и повышение постсистолического индекса свидетельствовали o гемодинамически значимом поражении одной из основных КА; сочетание нарушений локальной сократимости и дополнительной ЗФР ассоциировалось с множественным поражением КА.

Заключение

Заключение. Применение СТ ЭхоКГ с оценкой миокардиальной работы и выявлением зоны функционального риска в сочетании с парадоксальными механизмами продольной деформации при ОКСбпST позволяет прогнозировать поражение коронарных артерий, отбирать больных с угрозой неблагоприятного исхода независимо от степени риска по GRACE, определять показания для безотлагательной инвазивной диагностики, выбирать оптимальный метод реваскуляризации.

Aim

Aim. The study aimed at evaluating the role of the left ventricular (LV) longitudinal strain (LS) measurement and the left ventricle myocardial work parameters in predicting coronary artery disease (CAD), and determining the indications for early invasive diagnosis and treatment in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

Materials and methods

Materials and methods. The study included 51 patients aged from 41 to 93 years who were admitted at the Institute clinic with a diagnosis of NSTE-ACS. Upon admission, the risk of hospital mortality was assessed using GRACE risk score; standard echocardiography (EchoCG) and speckle tracking echocardiography (ST EchoCG) were performed to assess the LV longitudinal strain and the LV myocardial work parameters, and coronary angiography (CAG) was performed within 48 hours. The comparison group consisted of 20 volunteers without CAD.

Results

Results. According to the risk assessment with the GRACE score, the patients with low and moderate risk made 41 and 47 %, respectively. Local contractility disorders during standard EchoCG were detected in 15 patients (29 %). When analyzing regional parameters of longitudinal strain and myocardial work, the greatest prognostic value in identifying patients with hemodynamically significant changes in the coronary arteries (CAs) was demonstrated by the functional risk area (FRA) of 4 or more adjacent segments with a myocardial work index ≤1400 mmHg x% (sensitivity and specificity 84,2 and 78,1 %, AUC=0,83). In the dysfunctional segments of the risk zone in almost all patients, a paradoxical mechanism of deformation was detected in the form of post-systolic shortening with a post-systolic index (PSI) reaching a value of ≥20 % at least in one of the adjacent segments. The combination of a significant increase in PSI and the detection of FRA limited to 3 segments indicated the acuity of coronary insufficiency, hemodynamically significant stenosis (sensitivity and specificity 84 % and 79 %). When distributing patients, taking into account the data of standard EchoCG and ST EchoCG with the assessment of myocardial work, in the absence of significant disturbances in systolic function, the patients with intact main CAs or insignificant changes in the main CAs prevailed; among patients without visual impairment of contractility, the detected FRA indicated a hemodynamically significant damage of one of the main CAs; a combination of local contractility disorders and additional FRA was associated with multiple CA damage.

Conclusion

Conclusion. The use of ST EchoCG with the assessment of myocardial work and identification of the functional risk area in NSTE-ACS patients makes it possible to predict CAD, detect patients at risk of an unfavorable outcome regardless of the GRACE risk level, determine indications for immediate invasive diagnostics, and choose the optimal method of revascularization.

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The authors declare that there are no conflicts of interest present.