Schnaack S D, Siegmund P, Spes C H, Tammen A R, Theisen K, Angermann C E
Department of Medicine, Klinikum Innenstadt, University of Munich, Germany.
Coron Artery Dis. 2000 Oct;11(7):549-54. doi: 10.1097/00019501-200010000-00006.
A major limitation of stress echocardiography remains poor image quality.
To investigate the effects of transpulmonary contrast echocardiography (TCE) with BY 963 on endocardial border delineation, detectability of wall motion abnormalities and interobserver variability at rest and during dobutamine stress echocardiography (DSE) in subjects with technically limited baseline echocardiograms.
BY 963 was administered intravenously to 36 patients (5 ml for parasternal LAX/SAX, 10 ml for apical four-chamber/two-chamber view) both at rest and at peak stress during DSE. Two observers applied a delineation score (0, endocardial border not visible; 1 border poorly visible; and 2, border clearly visible) to 12 wall segments in the parasternal and 10 in the apical views both before and after administration of BY 963. A 16-segment wall-motion score was used.
In parasternal views, the delineation score was not improved by TCE. In the apical views, TCE significantly increased the delineation score (from 14.1 +/- 5.4 to 20.7 +/- 4.2 at rest and from 14.6 +/- 5.7 to 21.7 +/- 4.1 under stress, both P< 0.01). For 18 of 25 patients with coronary artery disease (> or = 70% stenosis) results of DSE were positive before TCE, whereas results were positive for 21 patients during TCE. For 10 of 11 patients without coronary artery disease, results of DSE were negative both before and during TCE. For the apical delineation score, interobserver variability was decreased significantly by TCE (from 19.5 +/- 19.6 to 8.2 +/- 15.6% at rest and from 20.2 +/- 19.6 to 3.3 +/- 11.4% at peak stress, both P< 0.01).
TCE enhances endocardial border delineation in apical views at rest and during DSE, resulting in a decrease of interobserver variability and an improvement in assessment of wall motion. Use of TCE, at least how it was applied in this investigation, seems not to be indicated for parasternal projections.
负荷超声心动图的一个主要局限性仍然是图像质量差。
探讨经肺对比超声心动图（TCE）联合BY 963对基线超声心动图技术受限患者静息及多巴酚丁胺负荷超声心动图（DSE）时心内膜边界描绘、室壁运动异常检测及观察者间变异性的影响。
对36例患者在静息及DSE负荷峰值时静脉注射BY 963（胸骨旁长轴/短轴视图注射5 ml，心尖四腔/两腔视图注射10 ml）。两名观察者在注射BY 963前后对胸骨旁视图的12个室壁节段及心尖视图的10个室壁节段应用描绘评分（0分，心内膜边界不可见；1分，边界可见性差；2分，边界清晰可见）。采用16节段室壁运动评分。
在胸骨旁视图中，TCE未改善描绘评分。在心尖视图中，TCE显著提高了描绘评分（静息时从14.1±5.4提高到20.7±4.2，负荷时从14.6±5.7提高到21.7±4.1，P均<0.01）。25例冠状动脉疾病（狭窄≥７０％）患者中，18例在TCE前DSE结果为阳性，而TCE时21例结果为阳性。11例无冠状动脉疾病的患者中，10例在TCE前后DSE结果均为阴性。对于心尖描绘评分，TCE显著降低了观察者间变异性（静息时从19.5±19.6％降至8.2±15.6％，负荷峰值时从20.2±19.6％降至3.3±11.4％，P均<0.01）。
TCE可增强静息及DSE时心尖视图的心内膜边界描绘，降低观察者间变异性并改善室壁运动评估。TCE的应用，至少在本研究中的应用方式，似乎不适用于胸骨旁投照。
