Usporedba osjetljivosti procjene kontraktilnosti miokarda standardnom ehokardiografijom i studijom deformacije miokarda u akutnom koronarnom sindromu bez ST elevacije

doctoral thesis

• Title (english): Comparing sensitivity of standard visual regional wall motion abnormality assessment and 2-d myocardial strain analysis in acute coronary syndrome without ST segment elevation,
• Author: Daniel Lovrić
• Mentor: Jadranka Šeparović-Hanževački (mentor)
• Committee member: Šime Manola (predsjednik povjerenstva)
• Committee member: Edvard Galić (član povjerenstva)
• Committee member: Hrvoje Pintarić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2023-12-04, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Universal decimal classification (UDC): 616 - Pathology. Clinical medicine

Abstract

Uvod: Dijagnostika i liječenje akutnog koronarnog sindroma bez elevacije ST segmenta (NSTEMI) i dalje predstavljaju veliki izazov. Promjena koncentracije srčanih enzima ukazuje na moguće postojanje značajne stenoze krvne žile i često predstavlja glavnu indikaciju za hitnu koronarografiju. Dijagnostička metoda koja bi u ovom kontekstu ukazala na postojanje stenoze pojedine srčane arterije, bila bi od velike pomoći interventnom kardiologu tijekom same koronarografije te bi od rane revaskulerizacije imao koristi i sam pacijent.
Cilj rada: Cilj ovog rada bio je usporediti dijagnostičku preciznost dvodimenzijske studije deformacije miokarda (DSDM) i vizualne analize ispada kontraktiliteta miokarda (VIK) u postojanju stenoze pojedine srčane arterije u bolesnika s NSTEMI.
Metode: U istraživanje je uključeno 115 ispitanika s NSTEMI koji prethodno nisu imali dijagnosticiranu koronarnu bolest, srčano zatajenje, strukturnu bolest srca niti su imali blok lijeve grane u elektrokardiogramu tijekom prijema. Svim ispitanicima je učinjen je ehokardiografski pregled, a zatim koronarna angiografija. Ispitivač koji je učinio koronarografiju, nije imao uvid u nalaz ehokardiografije. Pored klasične ehokardiografije, ehokardiografska analiza je uključivala DSDM tijekom koje je zabilježena regionalna i ukupna deformacija miokarda te posebno epikardijalna i endokardijalna deformacija svakog segmenta. Ukupno 59 ispitanika imalo je stenozu lijeve prednje silazne arterije ili lijeve glavne srčane arterije (LCA), 46 stenozu lijeve obodne arterije (LCx), 44 stenozu desne srčane arterije (RCA), a 26 ispitanika nije imalo značajnu stenozu niti jedne srčane arterije. Uspoređene su antropometrijske, laboratorijski i ehokardiografski parametri između ispitanika s i bez stenoze te između ispitanika s postojanjem stenoze srčane arterije od interesa i ostalih ispitanika (sa stenozama ostalih srčanih arterija i onih bez stenoze srčane arterije).
Rezultati: Brojni parametri regionalne deformacije miokarda su bili povezani sa stenozom pojedine krvne žile i dobro su korelirali s njezinim opskrbnim područjem, dok se isto nije moglo zaključiti za niti jedan parametar VIK. Terapija antagonistima Ca kanala, hiperlipoproteinemija, viši dijastolički tlak pri prijemu i deformacija medijalnog prednjeg segmenta miokarda (LSMA) bili su neovisno povezani sa stenozom LCA (dijagnostička preciznost LSMA iznosila je 73.4%). Epikardijalna deformacija bazalnog
inferiornog segmenta bila je neovisno povezana s prisustvom stenoze RCA uz dijagnostičku preciznost od 69%. Deformacija bazalnog posteriornog segmenta je najbolje predviđala postojanje stenoze LCx uz dijagnostičku preciznost 71.2%.
Zaključak: DSDM je bolja dijagnostička metoda u predviđanju postojanja stenoze pojedine srčane arterije naspram VIK u ispitanika s NSTEMI.

Abstract (english)

Introduction: Diagnosis and treatment of acute coronary syndrome without persistent ST-segment elevation (NSTEMI) remains a major challenge. A change in the concentration of cardiac enzymes indicates the possible existence of significant blood vessel stenosis and is often the main indication for emergency coronary angiography. A diagnostic method that would indicate the existence of stenosis of a particular coronary artery in this context would be of great help to the interventional cardiologist during coronary angiography and the patient himself would benefit from early revascularization.
Aim: The aim of this study is to prove right echocardiographic assessment of myocardial ischemia a two-dimensional study of myocardial deformation (strain) with significantly higher sensitivity and specificity to revealing ischemia caused by stenosis of one or more coronary arteries compared to standard echocardiographic assessment of regional wall motion abnormalities (RWMA).
Method: The study included 115 subjects with NSTEMI who had not previously been diagnosed with coronary heart disease, heart failure, structural heart disease, or had a left bundle branch block in the electrocardiogram during admission. All subjects underwent echocardiographic examination followed by coronary angiography. The examiner who did the coronary angiography had no insight into the echocardiography findings. In addition to classical echocardiography, echocardiographic analysis included DSDM during which regional and total myocardial strain and epicardial and endocardial strain of each segment were recorded. A total of 59 subjects had left anterior descendens or left main stenosis (LCA), 46 left circumflex artery stenosis (LCx), 44 right coronary artery stenosis (RCA), and 26 subjects did not have significant coronary artery stenosis. Anthropometric, laboratory and echocardiographic parameters were compared between subjects with and without stenosis and between subjects with coronary artery stenosis of interest and other subjects (with stenoses of other coronary arteries and those without coronary artery stenosis).
Results: Numerous parameters of regional myocardial deformity were associated with stenosis of an individual blood vessel and they are correlated well with its supply area, while the same would not be concluded for any VIK parameter. Calcium channel blockers, hyperlipoproteinemia, higher diastolic pressure at admission, and medial anterior myocardial strain (LSMA) were independently associated with LCA stenosis (diagnostic accuracy of LSMA was 73.4%). Epicardial strain of the basal inferior segment was independently associated with the presence of RCA stenosis with diagnostic accuracy of 69%. Deformation of the basal posterior segment best predicted the existence of LCx stenosis with a diagnostic accuracy of 71.2%.
Conclusion: A two-dimensional study of myocardial deformity has greater diagnostic accuracy versus RWMA in predicting the existence of NSTEMI.

• Keywords: Akutni infarkt miokarda bez elevacije ST segmenta; Ehokardiografija; Studija deformacije miokarda; Globalna uzdužna deformacija.
• Keywords (english): Acute myocardial infarction without ST segment elevation; Echocardiography; Myocardial deformation imaging; Global longitudinal strain.
• Language: croatian
• URN:NBN: urn:nbn:hr:105:295488
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
• Type of resource: Text
• Extent: 127 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-12-20 12:18:46