Lewis J F, Lin L, McGorray S, Pepine C J, Doyle M, Edmundowicz D, Holubkov R, Pohost G, Reichek N, Rogers W, Sharaf B L, Sopko G, Merz C N
WISE Clinical Centers, Division of Cardiology, University of Florida, Gainesville, USA.
J Am Coll Cardiol. 1999 May;33(6):1462-8. doi: 10.1016/s0735-1097(99)00076-5.
The aim of this project was to assess the utility of dobutamine stress echocardiography (DSE) for evaluation of women with suspected ischemic heart disease.
Most investigations addressing efficacy of diagnosis and treatment of coronary artery disease (CAD) have been performed in predominantly male populations. As part of the Women's Ischemia Syndrome Evaluation (WISE) study, DSE was assessed in women participating at the University of Florida clinical site.
Women with chest pain or other symptoms suggestive of myocardial ischemia and clinically indicated coronary angiography were eligible for the WISE study. Enrolled subjects underwent DSE using a modified protocol. Coronary stenosis was assessed by core laboratory quantitative coronary angiography (QCA).
The 92 women studied ranged in age from 34 to 82 years (mean 57.5). All women had > or = 1 major risk for CAD, and most (89, 97%) had > or = 2 risk factors. In 78 women (85%), left ventricular wall motion was normal at baseline and during peak infusion. The remaining 14 women had wall motion abnormalities during DSE. By QCA, 25 women (27%) had > or = 50% coronary stenosis, including 10 with single-vessel obstruction. Dobutamine stress echocardiography was abnormal in 10 of these 25 women, yielding overall sensitivity of 40%, and 60% for multivessel stenosis. Exclusion of women with inadequate heart rate response yielded overall sensitivity of 50%, and 81.8% for multivessel stenosis. Dobutamine stress echocardiography was normal in 54 of the 67 women with < 50% coronary narrowing, specificity 80.6%.
Dobutamine stress echocardiography reliably detects multivessel stenosis in women with suspected CAD. However, DSE is usually negative in women with single-vessel stenosis, and in the larger subset without coronary stenosis. Ongoing protocols of the WISE study are expected to improve diagnostic accuracy in women with single-vessel disease, as well as provide important data in the substantial number of women with chest pain but without epicardial coronary artery stenosis.
本项目旨在评估多巴酚丁胺负荷超声心动图（DSE）在评估疑似缺血性心脏病女性患者中的应用价值。
大多数关于冠状动脉疾病（CAD）诊断和治疗效果的研究主要在男性人群中进行。作为女性缺血综合征评估（WISE）研究的一部分，在佛罗里达大学临床站点参与研究的女性中对DSE进行了评估。
有胸痛或其他提示心肌缺血症状且临床表明需进行冠状动脉造影的女性符合WISE研究的条件。入选的受试者采用改良方案进行DSE检查。冠状动脉狭窄通过核心实验室定量冠状动脉造影（QCA）进行评估。
研究的92名女性年龄在34至82岁之间（平均57.5岁）。所有女性均有≥1项CAD主要危险因素，大多数（89名，97%）有≥2项危险因素。78名女性（85%）在基线和峰值输注时左心室壁运动正常。其余14名女性在DSE期间有壁运动异常。通过QCA，25名女性（27%）有≥50%的冠状动脉狭窄，其中10名有单支血管阻塞。这25名女性中有10名多巴酚丁胺负荷超声心动图异常，总体敏感性为40%，多支血管狭窄的敏感性为60%。排除心率反应不足的女性后，总体敏感性为50%，多支血管狭窄的敏感性为81.8%。67名冠状动脉狭窄<50%的女性中有54名多巴酚丁胺负荷超声心动图正常，特异性为80.6%。
多巴酚丁胺负荷超声心动图能可靠地检测出疑似CAD女性患者的多支血管狭窄。然而，DSE在单支血管狭窄的女性以及无冠状动脉狭窄的较大亚组中通常为阴性。WISE研究正在进行的方案有望提高单支血管疾病女性的诊断准确性，并为大量有胸痛但无冠状动脉狭窄的女性提供重要数据。
