BACKGROUND The aim of this study was to investigate whether speckle-tracking echocardiography (STE) improves the detection of myocardial infarction (MI) over visual assessment of systolic wall motion abnormalities (SWMAs) using delayed enhancement cardiac magnetic resonance imaging as a reference. METHODS Transthoracic echocardiography was performed in 95 patients with first ST segment elevation MI 110 days (interquartile range, 97-171 days) after MI and in 48 healthy control subjects. Two experienced observers independently assessed SWMAs. Separately, longitudinal peak negative, peak systolic, end-systolic, global strain, and strain rate were measured and averaged for the American Heart Association-recommended coronary artery perfusion territories. Receiver operating characteristic analysis was used to determine a single optimal cutoff value for each strain parameter. The diagnostic accuracy of an algorithm combining visual assessment and STE was evaluated. RESULTS Median infarct size and transmurality were 15% (interquartile range, 7%-24%) and 64% (interquartile range, 46%-78%), respectively. Sensitivity, specificity, and accuracy of visual assessment to detect MI were 74% (95% CI, 63%-82%), 85% (95% CI, 72%-93%), and 78% (95% CI, 70%-84%), respectively. Among the strain parameters, SR had the highest diagnostic accuracy (area under the curve, 0.88; 95% CI, 0.83-0.94; cutoff value, -0.97 sec-1). The combination with STE improved sensitivity compared with visual assessment alone (94%; 95% CI, 86%-97%; P < .001), minimally affecting specificity (79%; 95% CI, 65%-89%; P = .607). Overall accuracy improved to 89% (95% CI, 82%-93%; P = .011). Multivariate analysis accounting for age and sex demonstrated that SR was independently associated with MI (odds ratio, 2.0; 95% CI, 1.6-2.7). CONCLUSIONS The sensitivity and diagnostic accuracy of visually detecting chronic MI by assessing SWMAs are moderate but substantially improve when adding STE.

中文翻译：

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将斑点跟踪超声心动图添加到收缩壁运动异常的视觉评估中可以改善心肌梗塞的检测。

背景技术这项研究的目的是研究通过延迟增强心脏磁共振成像作为参考，通过视觉评估收缩壁运动异常（SWMA），斑点追踪超声心动图（STE）是否能改善心肌梗塞（MI）的检测。方法经胸超声心动图检查在95例心梗后110天（四分位间距为97-171天）内首次ST段抬高的患者和48位健康对照者进行。两名经验丰富的观察员独立评估了SWMA。分别对美国心脏协会推荐的冠状动脉灌注区域的纵向峰值阴性，收缩期峰值，收缩末期，总应变和应变率进行测量并取平均值。接收器工作特性分析用于确定每个应变参数的单个最佳截止值。评估了将视觉评估和STE相结合的算法的诊断准确性。结果中度梗死面积和透壁率分别为15％（四分位间距，7％-24％）和64％（四分位间距，46％-78％）。视觉评估检测MI的敏感性，特异性和准确性分别为74％（95％CI，63％-82％），85％（95％CI，72％-93％）和78％（95％CI，70 ％-84％）。在应变参数中，SR具有最高的诊断准确性（曲线下面积为0.88； 95％CI为0.83-0.94；临界值为-0.97 sec-1）。与单独的视觉评估相比，与STE联合使用可提高敏感性（94％； 95％CI，86％-97％； P <.001），对特异性的影响极小（79％； 95％CI，65％-89％； P = .607）。总体准确度提高到89％（95％CI，82％-93％； P = .011）。对年龄和性别进行的多变量分析表明，SR与MI独立相关（优势比为2.0； 95％CI为1.6-2.7）。结论通过评估SWMAs视觉检测慢性MI的敏感性和诊断准确性中等，但添加STE时可显着提高。