DOBUTAMINE STRESS ECHOCARDIOGRAPHY FOR DETECTION AND ASSESSMENT OF CORONARY-ARTERY DISEASE
DOBUTAMINE STRESS ECHOCARDIOGRAPHY FOR DETECTION AND ASSESSMENT OF CORONARY-ARTERY DISEASE
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DOI：
10.1016/0735-1097(92)90325-h
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发表时间：
1992-05-01
影响因子：
24
通讯作者：
OAKLEY, CM
中科院分区：
文献类型：
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作者：
MAZEIKA, PK;NADAZDIN, A;OAKLEY, CM
使用多巴酚丁胺输注进行负荷超声心动图检测冠状动脉疾病是运动负荷测试的潜在替代方案，具有一些理论上的优点。 50 名未接受心脏活性药物治疗的患者在增量多巴酚丁胺输注期间（每分钟 5、10、15 和 20 μg/kg 体重，每次剂量 8 分钟）进行了二维超声心动图和 12 导联心电图 (ECG) 前瞻性研究。使用 11 段左心室模型分析图像。所有患者均接受了相关运动心电图和冠状动脉造影，结果显示 14 例患者冠状动脉正常，36 例患者存在明显病变（大于或等于 70% 直径狭窄）。多巴酚丁胺输注期间的峰值速率-压力乘积为 18,845 +/- 4,156，而运动时为 23,740 +/- 6,158 mm Hg/min（p < 0.01）。室壁运动分析的观察者间一致性良好（kappa 系数 = 0.77）。使用基线 (n = 14) 或可逆 (n = 24) 局部不协同来定义异常多巴酚丁胺超声心动图，检测冠状动脉疾病的敏感性为 78%，特异性为 93%。多巴酚丁胺心电图的相应数据分别为 47% 和 71%，运动心电图的相应数据分别为 72% 和 71%。多普勒彩色血流成像中新发二尖瓣反流的发生 (n = 4) 将敏感性提高至 81%，且不损失特异性。在 12 名单支血管疾病患者中观察到 6 名 (50%) 观察到诱导性不协同或新的二尖瓣反流，10 名双血管疾病患者中观察到 6 名 (60%) 患者，14 名三支血管疾病患者中观察到 12 名 (86%) 患者出现诱导不协同或新二尖瓣反流。瞬态不协同作用的位点提供了额外的定位信息。与没有缺血超声心动图证据的冠状动脉疾病患者相比，运动持续时间和诊断 ST 段移位的时间较短（均 p < 0.05）。多巴酚丁胺输注期间的副作用轻微且短暂。多巴酚丁胺负荷超声心动图耐受性良好，可用于检测和评估冠状动脉疾病，并且适用于无法运动的患者。
Stress echocardiography with dobutamine infusion for detection of coronary artery disease is a potential alternative to exercise stress testing with some theoretic advantages. Fifty patients who were not receiving cardioactive medication were prospectively studied with two-dimensional echocardiography and 12-lead electrocardiography (ECG) during incremental dobutamine infusion (5, 10, 15 and 20-mu-g/kg body weight per min, each dose for 8 min). images were analyzed by using an 11-segment left ventricular model. All patients underwent correlative exercise ECG and coronary angiography, which revealed normal coronary arteries in 14 and significant disease (greater-than-or-equal-to 70% diameter stenosis) in 36.Peak rate-pressure product during dobutamine infusion was 18,845 +/- 4,156 versus 23,740 +/- 6,158 mm Hg/min on exercise (p < 0.01). Interobserver concordance for wall motion analysis was good (kappa coefficient = 0.77). The use of baseline (n = 14) or reversible (n = 24) regional asynergy to define an abnormal dobutamine echocardiogram resulted in a sensitivity for detecting coronary artery disease of 78% and a specificity of 93%. Corresponding data for the dobutamine ECG were 47% and 71% and for the exercise ECG were 72% and 71%, respectively. The development of new mitral regurgitation on Doppler color flow imaging (n = 4) improved sensitivity to 81% without loss of specificity.Inducible asynergy or new mitral regurgitation was observed in 6 (50%) of 12 patients with single-, 6 (60%) of 10 with double- and 12 (86%) of 14 with triple-vessel disease. The site of transient asynergy provided additional localizing information. Exercise duration and time to diagnostic ST segment shift were shorter in patients with coronary artery disease with versus those without echocardiographic evidence of ischemia (both p < 0.05). Side effects during dobutamine infusion were mild and short-lived.Dobutamine stress echocardiography is well tolerated, is useful for detection and assessment of coronary artery disease and is applicable to patients unable to exercise.