DOBUTAMINE ECHOCARDIOGRAPHY IN PATIENTS WITH CHEST PAIN AND NORMAL CORONARIES

我们已经证明，经食道多巴酚丁胺负荷超声心动图 一种安全可靠的冠心病患者评估方法 动脉疾病。因此，我们试图确定患者是否 胸痛和冠状动脉正常的患者有类似的证据 多巴酚丁胺负荷时心肌缺血的评价 经食道超声心动图。为此，我们研究了43名患者 胸痛，冠状动脉造影正常(13名男性，年龄49q10岁)， 其中13例出现缺血性心电图反应 跑步机运动。我们还对62名患者进行了同样的技术治疗。 冠心病患者和21名正常志愿者。多巴酚丁胺 84%有胸痛和正常胸痛患者的应激性胸痛 冠状动脉，在50%的冠状动脉疾病患者中，在 没有一名正常的志愿者。缺血性心电图学 28%的胸痛和冠状动脉正常的患者发生了变化 在51%的冠状动脉疾病患者中，仅在 5%的正常志愿者。无一例发生室壁运动异常 在胸痛和冠状动脉正常的患者中，89%的 冠心病患者与非正常人群 志愿者。因此，尽管成功挑衅了典型的 胸痛和/或心电图改变，胸痛患者 而正常的冠状动脉没有心肌缺血的证据 经食道多巴酚丁胺负荷超声心动图检查。因此， 这项技术似乎是一种有用和安全的身份识别方法 非缺血型胸痛的患者。

We have shown that transesophageal dobutamine stress echocardiography is a safe and reliable method for the assessment of patients with coronary artery disease. Accordingly, we sought to determine whether patients with chest pain and normal coronary arteries have similar evidence of myocardial ischemia during dobutamine stress assessed by means of transesophageal echocardiography. To this end, we studied 43 patients with chest pain and normal coronary angiograms (13 men age 49q10 years), 13 of whom had ischemic-appearing electrocardiographic responses to treadmill exercise. We also performed the same technique in 62 patients with coronary artery disease and in 21 normal volunteers. Dobutamine stress induced chest pain in 84% of patients with chest pain and normal coronary arteries, in 50% of coronary artery diseased patients, and in none of the normal volunteers. Ischemic-appearing electrocardiographic changes developed in 28% of patients with chest pain and normal coronary arteries, in 51% of patients with coronary artery disease, and in only 5% of the normal volunteers. Wall motion abnormalities occurred in none of the patients with chest pain and normal coronary arteries, in 89% of the patients with coronary artery disease and in none of the normal volunteers. Hence, in spite of the successful provocation of typical chest pain and/or electrocardiographic changes, patients with chest pain and normal coronary arteries did not have evidence of myocardial ischemia during transesophageal dobutamine stress echocardiography. Therefore, this technique appears as a useful and safe method for the identification of patients with chest pain of nonischemic origin.