Sze L, Attenhofer Jost C H, Lüscher T F, Amann F W, Jenni R
Universitätsspital Zürich.
Schweiz Med Wochenschr. 2000 Jun 10;130(23):878-88.
Stress echocardiography is increasingly accepted as a reliable, noninvasive method for assessment of coronary artery disease. We retrospectively analysed the results of the first 100 consecutive patients (79 males, 62 +/- 10 years), who had both stress echocardiography and coronary angiography within 3 months without intercurrent revascularisation. In 71% of the patients treadmill- was performed and in 29% dobutamine-stress echocardiography. No patient had severe side effects. In the 100 patients, positive predictive accuracy for detection of significant coronary artery disease was 95% and for multivessel disease 80%. There was no significant difference in positive predictive value for detection of significant stenosis in the posterior perfusion territory (left circumflex, right coronary artery), with 79% compared to the anterior perfusion territory (86%, p = ns). Sensitivity for the left circumflex (60%) tended to be lower compared to the right coronary artery (76%) or left anterior descending coronary artery (82%) (p = ns). Despite poorer echocardiographic image quality in dobutamine-stress echocardiography patients, there was no significant difference between treadmill- and dobutamine-stress echocardiography regarding the positive predictive value for detection of coronary artery disease (98 vs 92%) or for recognition of multivessel disease (79 vs 79%) (p = ns). False results of stress echocardiography were rare (7%): false positive results were more common in the presence of wall motion abnormalities at rest, false negative results after an insufficient stress-induced increase in heart rate. Gender or left ventricular hypertrophy had no impact on stress echocardiography results (p = ns). In conclusion, both dobutamine- and treadmill-stress echocardiography are reliable, sensitive methods for non-invasive assessment of coronary artery disease; this is also valid in women and in left ventricular hypertrophy.
负荷超声心动图作为一种可靠的、非侵入性的冠状动脉疾病评估方法，越来越被人们所接受。我们回顾性分析了连续100例患者（79例男性，年龄62±10岁）的结果，这些患者在3个月内同时接受了负荷超声心动图和冠状动脉造影检查，期间未进行血管重建术。71%的患者进行了平板运动试验，29%的患者进行了多巴酚丁胺负荷超声心动图检查。无患者出现严重副作用。在这100例患者中，检测显著冠状动脉疾病的阳性预测准确率为95%，检测多支血管疾病的阳性预测准确率为80%。后灌注区域（左旋支、右冠状动脉）检测显著狭窄的阳性预测值与前灌注区域（86%）相比无显著差异（79%，p=无显著性差异）。左旋支的敏感性（60%）与右冠状动脉（76%）或左前降支冠状动脉（82%）相比有降低趋势（p=无显著性差异）。尽管多巴酚丁胺负荷超声心动图检查患者的超声心动图图像质量较差，但在检测冠状动脉疾病的阳性预测值（98%对92%）或识别多支血管疾病方面（79%对79%），平板运动试验和多巴酚丁胺负荷超声心动图检查之间无显著差异（p=无显著性差异）。负荷超声心动图的假结果很少（7%）：假阳性结果在静息时存在室壁运动异常的情况下更常见，假阴性结果在负荷诱导的心率增加不足后出现。性别或左心室肥厚对负荷超声心动图结果无影响（p=无显著性差异）。总之，多巴酚丁胺负荷超声心动图和平板运动试验都是可靠、敏感的冠状动脉疾病非侵入性评估方法；这在女性和左心室肥厚患者中同样有效。
