usfdУльтразвуковая и функциональная диагностикаUltrasound & Functional Diagnostics1607-07712408-9494RDS-Media Ltd.10.24835/1607-0771-2019-4-60-69usfd-120Research ArticleУльтразвуковая диагностика заболеваний сердца и сосудовCardiovascular UltrasoundВлияние величины локальной продольной систолической деформации миокарда левого желудочка на риск возникновения сердечно-сосудистых осложнений после острого коронарного синдромаLeft ventricular local longitudinal systolic strain magnitude in prediction of risk of cardiovascular events in patients after acute coronary syndromeШвецДенис АнатольевичShvecD. A.denpost-card@mail.ruПоветкинС. В.PovetkinS. V.noemail@neicon.ruБУЗ Орловской области “Орловская областная клиническая больница”Orel Clinical Regional HospitalФГБОУ ВО “Курский государственный медицинский университет” Министерства здравоохранения Российской ФедерацииKursk State Medical University201928032024046069Copyright © Швец Д.А., Поветкин С.В., 20242024Швец Д.А., Поветкин С.В.Shvec D.A., Povetkin S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://usfd.rdsmedia.ru/jour/article/view/120

Целью исследования было изучение влияния величины локальной продольной систолической деформации миокарда левого желудочка на риск возникновения сердечно-сосудистых осложнений после острого коронарного синдрома. Обследовано 146 больных с верифицированным острым коронарным синдромом, которые были разделены на две группы. Критерием разделения на группы было появление большого кардиоваскулярного события (major adverse cardiac events (MACE)) на протяжении периода наблюдения после выписки больного из стационара. 1-ю группу составили 45 больных с осложненным течением ишемической болезни сердца, 2-ю группу - 101 больной с неосложненным течением. Медиана срока наблюдения составила 47 мес, 25-75-й процентили - 32-60 мес. Измерение продольной систолической деформации передне-перегородочной, нижней и нижне-перегородочной стенок левого желудочка проводилось в апикальных сечениях методом двухмерного отслеживания пятен серой шкалы ультразвукового изображения. Анализ выживаемости больных по методу Каплана-Майера показал, что при использовании исходных показателей деформации средних сегментов нижней и нижне-перегородочной стенок левого желудочка можно на протяжении 5 лет после перенесенного острого коронарного синдрома оценивать риск сердечно-сосудистых осложнений (P = 0,01 и P = 0,002 соответственно). При снижении величины продольной систолической деформации нижней и нижне-перегородочной стенок менее 14% вероятность осложненного течения ИБС у больных через 5 лет после острого коронарного синдрома увеличивается на более 20 и 30% соответственно. Таким обра зом, среди исследуемых пациентов с острым коронарным синдромом сниженная величина продольной систолической деформации среднего сегмента нижней и нижне-перегородочной стенок левого желудочка (<14%) является неблагоприятным фактором, свидетельствующим о повышенном риске сердечно-сосудистых осложнений на протяжении длительного периода наблюдения.

The aim of the study was to investigate the influence of left ventricular local longitudinal systolic strain magnitude on risk of cardiovascular events in patients after acute coronary syndrome. 146 patients with verified acute coronary syndrome were examined. According to major adverse cardiac events (MACE) appearance in the post-hospital follow-up period they were divided into two groups. 45 patients with MACE were included in the 1st group, 101 patients without MACE - in the 2nd one. The follow-up median was 47 months, (25-75th percentiles - 32-60 months). Longitudinal systolic strain of anterior septal, inferior, and inferior septal walls of left ventricle was evaluated at apical views by two-dimensional speckle-tracking echocardiography. According to the Kaplan-Mayer survival analysis, risk of cardiovascular events for 5 years after acute coronary syndrome may be assessed with the use of initial values of left ventricular inferior and inferior septal walls longitudinal systolic strain (P = 0.01 and P = 0.002, respectively). If value of inferior and inferior septal walls longitudinal systolic strain decreases by less than 14%, the probability of MACE in patients 5 years after acute coronary syndrome increases by more than 20 and 30%, respectively. Thus, reduced longitudinal systolic strain of left ventricular inferior and inferior septal walls in patients with acute coronary syndrome is an adverse prognostic factor of increased risk of cardiovascular events during the long-term follow-up.

ультразвуковое исследование сердца (эхокардиография)острый коронарный синдромпродольная деформациясердечно-сосудистый рисккривые выживаемости Каплана-Майераechocardiographyacute coronary syndromelongitudinal straincardiovascular riskKaplan Meier survival curvesReferencesSyyli N., Hautamaki M., Antila K., Mahdiani S., Eskola M., Lehtimaki T., Nikus K., Lyytikainen L.P., Oksala N., Hernesniemi J. Left ventricular ejection fraction adds value over the GRACE score in prediction of 6-month mortality after ACS: the MADDEC study // Open Heart. 2019. V. 6. No. 1. P. e001007. Doi: 10.1136/openhrt-2019-001007.Syyli N., Hautamaki M., Antila K., Mahdiani S., Eskola M., Lehtimaki T., Nikus K., Lyytikainen L.P., Oksala N., Hernesniemi J. Left ventricular ejection fraction adds value over the GRACE score in prediction of 6-month mortality after ACS: the MADDEC study // Open Heart. 2019. V. 6. No. 1. P. e001007. Doi: 10.1136/openhrt-2019-001007.Perelshtein Brezinov O., Klempfner R., Zekry S.B., Goldenberg I., Kuperstein R. Prognostic value of ejection fraction in patients admitted with acute coronary syndrome: a real world study // Medicine (Baltimore). 2017. V. 96. No. 9. P. e6226. Doi: 10.1097/MD.0000000000006226.Perelshtein Brezinov O., Klempfner R., Zekry S.B., Goldenberg I., Kuperstein R. Prognostic value of ejection fraction in patients admitted with acute coronary syndrome: a real world study // Medicine (Baltimore). 2017. V. 96. No. 9. P. e6226. Doi: 10.1097/MD.0000000000006226.Mukherjee J.T., Beshansky J.R., Ruthazer R., Alkofide H., Ray M., Kent D., Manning W.J., Huggins G.S., Selker H.P. In-hospital measurement of left ventricular ejection fraction and oneyear outcomes in acute coronary syndromes: results from the IMMEDIATE Trial // Cardiovasc. Ultrasound. 2016. V. 14. No. 1. P. 29. Doi: 10.1186/s12947-016-0068-1.Mukherjee J.T., Beshansky J.R., Ruthazer R., Alkofide H., Ray M., Kent D., Manning W.J., Huggins G.S., Selker H.P. In-hospital measurement of left ventricular ejection fraction and oneyear outcomes in acute coronary syndromes: results from the IMMEDIATE Trial // Cardiovasc. Ultrasound. 2016. V. 14. No. 1. P. 29. Doi: 10.1186/s12947-016-0068-1.Badano L.P., Muraru D. The good, the bad, and the ugly of using left ventricular longitudinal myocardial deformation by speckle-tracking echocardiography to assess patients after an acute myocardial infarction // Circ. Cardiovasc. Imaging. 2017. V. 10. No. 7. P. e006693. Doi: 10.1161/CIRCIMAGING.117.006693.Badano L.P., Muraru D. The good, the bad, and the ugly of using left ventricular longitudinal myocardial deformation by speckle-tracking echocardiography to assess patients after an acute myocardial infarction // Circ. Cardiovasc. Imaging. 2017. V. 10. No. 7. P. e006693. Doi: 10.1161/CIRCIMAGING.117.006693.Edvardsen T., Haugaa K.H. Strain echocardiography: from variability to predictability // JACC. Cardiovasc. Imaging. 2018. V. 11. No. 1. P. 35-37. Doi: 10.1016/j.jcmg.2017.03.012.Edvardsen T., Haugaa K.H. Strain echocardiography: from variability to predictability // JACC. Cardiovasc. Imaging. 2018. V. 11. No. 1. P. 35-37. Doi: 10.1016/j.jcmg.2017.03.012.Joyce E., Hoogslag G.E., Kamperidis V., Debonnaire P., Katsanos S., Mertens B., Marsan N.A., Bax J.J., Delgado V. Relationship between myocardial function, body mass index, and outcome after ST-segment-elevation myocardial infarction // Circ. Cardiovasc. Imaging. 2017. V. 10. No. 7. P. e005670. Doi: 10.1161/CIRCIMAGING.116.005670.Joyce E., Hoogslag G.E., Kamperidis V., Debonnaire P., Katsanos S., Mertens B., Marsan N.A., Bax J.J., Delgado V. Relationship between myocardial function, body mass index, and outcome after ST-segment-elevation myocardial infarction // Circ. Cardiovasc. Imaging. 2017. V. 10. No. 7. P. e005670. Doi: 10.1161/CIRCIMAGING.116.005670.Omar A.M., Bansal M., Sengupta P.P. Advances in echocardiographic imaging in heart failure with reduced and preserved ejection fraction // Circ. Res. 2016. V. 119. No. 2. P. 357-374. Doi: 10.1161/CIRCRESAHA.116.309128.Omar A.M., Bansal M., Sengupta P.P. Advances in echocardiographic imaging in heart failure with reduced and preserved ejection fraction // Circ. Res. 2016. V. 119. No. 2. P. 357-374. Doi: 10.1161/CIRCRESAHA.116.309128.Skaarup K.G., Iversen A., Jorgensen P.G., Olsen F.J., Grove G.L., Jensen J.S., Biering-Sorensen T. Association between layer-specific global longitudinal strain and adverse outcomes following acute coronary syndrome // Eur. Heart J. Cardiovasc. Imaging. 2018. V. 19. No. 12. P. 1334-1342. Doi: 10.1093/ehjci/jey004.Skaarup K.G., Iversen A., Jorgensen P.G., Olsen F.J., Grove G.L., Jensen J.S., Biering-Sorensen T. Association between layer-specific global longitudinal strain and adverse outcomes following acute coronary syndrome // Eur. Heart J. Cardiovasc. Imaging. 2018. V. 19. No. 12. P. 1334-1342. Doi: 10.1093/ehjci/jey004.Biering-Sorensen T., Biering-Sorensen S.R., Olsen V.F., Sengelov M., Jorgensen P.G., Mogelvang R., Shah A.M., Jensen J.S. Global longitudinal strain by echocardiography predicts long-term risk of cardiovascular morbidity and mortality in a low-risk general population: the Copenhagen City Heart Study // Circ. Cardiovasc. Imaging. 2017. V. 10. No. 3. P. e005521. Doi: 10.1161/CIRCIMAGING.116.005521.Biering-Sorensen T., Biering-Sorensen S.R., Olsen V.F., Sengelov M., Jorgensen P.G., Mogelvang R., Shah A.M., Jensen J.S. Global longitudinal strain by echocardiography predicts long-term risk of cardiovascular morbidity and mortality in a low-risk general population: the Copenhagen City Heart Study // Circ. Cardiovasc. Imaging. 2017. V. 10. No. 3. P. e005521. Doi: 10.1161/CIRCIMAGING.116.005521.Atici A., Barman H.A., Durmaz E., Demir K., Cakmak R., Tugrul S., Elitok A., Onur I., Sahin I., Oncul A. Predictive value of global and territorial longitudinal strain imaging in detecting significant coronary artery disease in patients with myocardial infarction without persistent ST-segment elevation // Echocardiography. 2019. V. 36. No. 3. P. 512-520. Doi: 10.1111/echo.14275.Atici A., Barman H.A., Durmaz E., Demir K., Cakmak R., Tugrul S., Elitok A., Onur I., Sahin I., Oncul A. Predictive value of global and territorial longitudinal strain imaging in detecting significant coronary artery disease in patients with myocardial infarction without persistent ST-segment elevation // Echocardiography. 2019. V. 36. No. 3. P. 512-520. Doi: 10.1111/echo.14275.Biering-Sorensen T., Jensen J.S., Pedersen S.H., Galatius S., Fritz-Hansen T., Bech J., Olsen F.J., Mogelvang R. Regional longitudinal myocardial deformation provides incremental prognostic information in patients with ST-segment elevation myocardial infarction // PLoS One. 2016. V. 11. No. 6. P. e0158280. Doi: 10.1371/journal.pone.0158280.Biering-Sorensen T., Jensen J.S., Pedersen S.H., Galatius S., Fritz-Hansen T., Bech J., Olsen F.J., Mogelvang R. Regional longitudinal myocardial deformation provides incremental prognostic information in patients with ST-segment elevation myocardial infarction // PLoS One. 2016. V. 11. No. 6. P. e0158280. Doi: 10.1371/journal.pone.0158280.Ibanez B., James S., Agewall S., Antunes M.J., Bucciarelli-Ducci C., Bueno H., Caforio A.L.P., Crea F., Goudevenos J.A., Halvorsen S., Hindricks G., Kastrati A., Lenzen M.J., Prescott E., Roffi M., Valgimigli M., Varenhorst C., Vranckx P., Widimsky P., ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) // Eur. Heart J. 2018. V. 39. No. 2. P. 119-177. Doi: 10.1093/eurheartj/ehx393.Ibanez B., James S., Agewall S., Antunes M.J., Bucciarelli-Ducci C., Bueno H., Caforio A.L.P., Crea F., Goudevenos J.A., Halvorsen S., Hindricks G., Kastrati A., Lenzen M.J., Prescott E., Roffi M., Valgimigli M., Varenhorst C., Vranckx P., Widimsky P., ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) // Eur. Heart J. 2018. V. 39. No. 2. P. 119-177. Doi: 10.1093/eurheartj/ehx393.Roffi M., Patrono C., Collet J.P., Mueller C., Valgimigli M., Andreotti F., Bax J.J., Borger M.A., Brotons C., Chew D.P., Gencer B., Hasenfuss G., Kjeldsen K., Lancellotti P., Landmesser U., Mehilli J., Mukherjee D., Storey R.F., Windecker S., ESC Scientific Document Group. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC) // Eur. Heart J. 2016. V. 37. No. 3. P. 267-315. Doi: 10.1093/eurheartj/ehv320.Roffi M., Patrono C., Collet J.P., Mueller C., Valgimigli M., Andreotti F., Bax J.J., Borger M.A., Brotons C., Chew D.P., Gencer B., Hasenfuss G., Kjeldsen K., Lancellotti P., Landmesser U., Mehilli J., Mukherjee D., Storey R.F., Windecker S., ESC Scientific Document Group. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC) // Eur. Heart J. 2016. V. 37. No. 3. P. 267-315. Doi: 10.1093/eurheartj/ehv320.Lang R.M., Badano L.P., Mor-Avi V., Afilalo J., Armstrong A., Ernande L., Flachskampf F.A., Foster E., Goldstein S.A., Kuznetsova T., Lancellotti P., Muraru D., Picard M.H., Rietzschel E.R., Rudski L., Spencer K.T., Tsang W., Voigt J.U. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging // J. Am. Soc. Echocardiogr. 2015. V. 28. No. 1. P. 1-39.e14. Doi: 10.1016/j.echo.2014.10.003.Lang R.M., Badano L.P., Mor-Avi V., Afilalo J., Armstrong A., Ernande L., Flachskampf F.A., Foster E., Goldstein S.A., Kuznetsova T., Lancellotti P., Muraru D., Picard M.H., Rietzschel E.R., Rudski L., Spencer K.T., Tsang W., Voigt J.U. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging // J. Am. Soc. Echocardiogr. 2015. V. 28. No. 1. P. 1-39.e14. Doi: 10.1016/j.echo.2014.10.003.Smiseth O.A., Torp H., Opdahl A., Haugaa K.H., Urheim S. Myocardial strain imaging: how useful is it in clinical decision making? // Eur. Heart J. 2016. V. 37. No. 15. P. 1196-1207. Doi: 10.1093/eurheartj/ehv529.Smiseth O.A., Torp H., Opdahl A., Haugaa K.H., Urheim S. Myocardial strain imaging: how useful is it in clinical decision making? // Eur. Heart J. 2016. V. 37. No. 15. P. 1196-1207. Doi: 10.1093/eurheartj/ehv529.Madry W., Karolczak M.A. Physiological basis in the assessment of myocardial mechanics using speckle-tracking echocardiography 2D. Part II // J. Ultrason. 2016. V. 16. No. 66. P. 304-316. Doi: 10.15557/JoU.2016.0031.Madry W., Karolczak M.A. Physiological basis in the assessment of myocardial mechanics using speckle-tracking echocardiography 2D. Part II // J. Ultrason. 2016. V. 16. No. 66. P. 304-316. Doi: 10.15557/JoU.2016.0031.Sicari R., Cortigiani L. The clinical use of stress echocardiography in ischemic heart disease // Cardio vasc. Ultrasound. 2017. V. 15. No. 1. P. 7. Doi: 10.1186/s12947-017-0099-2.Sicari R., Cortigiani L. The clinical use of stress echocardiography in ischemic heart disease // Cardio vasc. Ultrasound. 2017. V. 15. No. 1. P. 7. Doi: 10.1186/s12947-017-0099-2.

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