Uses and limitations of exercise Doppler echocardiography in the diagnosis of ischemic heart disease.
Uses and limitations of exercise Doppler echocardiography in the diagnosis of ischemic heart disease.
复制标题
运动多普勒超声心动图在诊断缺血性心脏病中的用途和局限性。
DOI：
10.1016/s0735-1097(87)80274-7
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发表时间：
1987
影响因子：
24
通讯作者：
A. Demaria
中科院分区：
文献类型：
--
作者：
M. Harrison;M. Smith;B. Friedman;A. Demaria
本研究验证了冠状动脉疾病可以通过血流速度和加速度的多普勒测量值的降低来识别的假设。我们对102名受试者（28名年轻对照者和74名老年患者）进行了连续波多普勒超声心动图检查，测定了主动脉血流速度和加速度对运动的反应，这些受试者在最大极限跑步机运动前、运动中和运动后立即接受了超声心动图检查。根据铊灌注显像结果对患者进行分组：I组=正常，II组=缺血伴或无既往梗死，III组=仅既往梗死。与年轻对照组（1.4±0.2 m/s和52.7±16 m/s）相比，I组（正常铊研究）患者（1.2±0.3 m/s和36.8±14 m/s /s, p < 0.005）和II组（缺血）患者（1.1±0.3 m/s和27.7±11 m/s, p < 0.0005）运动后的速度和加速度水平均显著降低。年龄相近的两组患者在铊显像上有缺血（II组）或无缺血（I组），最大速度差异无统计学意义（1.1±0.3 vs 1.2±0.3 m/s, p = NS），但加速度显著低于II组（27.7±11 vs 36.8±14 m/s, p < 0.05）。当I组和II组的运动能力值以达到的心率为基础归一化时，只观察到II组多支冠状动脉疾病患者的峰值加速度降低。结论：年轻健康人的主动脉血流速度和加速度随运动的增加而逐渐增加。由于正常和缺血患者对铊灌注显像的反应在质量上相似，因此通过运动多普勒记录主动脉血流减少不能可靠地用于识别冠心病个体患者。总体而言，铊显像显示灌注受损的患者的峰值加速度低于正常扫描的患者，这一发现在多血管疾病患者中尤为明显。
This study tested the hypothesis that coronary artery disease might be identified by a decrease in Doppler measurements of flow velocity and acceleration. The response of aortic blood flow velocity and acceleration to exercise was determined in 102 subjects (28 young control subjects and 74 older patients) who underwent continuous wave Doppler echocardiographic examination before, during and immediately after near maximal treadmill exercise. Patients were grouped according to the results of thallium perfusion imaging: Group I = normal, Group II = ischemia with or without prior infarction and Group III = prior infarction only. A significant decrease in the level of velocity and acceleration achieved with exercise was observed both in patients in Group I (normal thallium study) (1.2 ± 0.3 m/s and 36.8 ± 14 m/s per s, p < 0.005) and in patients in Group II (ischemia) (1.1 ± 0.3 m/s and 27.7 ± 11 m/s per s, p < 0.0005) compared with values in young control subjects (1.4 ± 0.2 m/s and 52.7 ± 16 m/s per s). When groups of patients of similar age who differed in the presence (Group II) or absence (Group I) of ischemia on thallium scintigraphy were compared, no difference was found for maximal velocity (1.1 ± 0.3 versus 1.2 ± 0.3 m/s, p = NS), but acceleration was significantly lower in Group II (27.7 ± 11 versus 36.8 ± 14 m/s per s, p < 0.05). When values in Groups I and II were normalized for exercise capacity on the basis of heart rate reached, a reduction was observed only for peak acceleration in Group II patients with multivessel coronary disease.It is concluded that aortic flow velocity and acceleration increase progressively with exercise in young healthy subjects. Because qualitatively similar responses are elicited in patients with normal and ischemic responses to thallium perfusion scintigraphy, a reduction in aortic blood flow by exercise Doppler recordings cannot be reliably used to identify individual patients with coronary artery disease. As a group, patients with evidence of impaired perfusion by thallium scintigraphy achieve a lower peak acceleration than do those with normal scans, a finding particularly marked in those with multivessel disease.