多巴酚丁胺-阿托品负荷超声心动图在左束支传导阻滞患者冠状动脉疾病诊断中的应用价值与局限性：一项多中心研究

Usefulness and limitations of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block. A multicentre study.

作者信息

Geleijnse M L, Vigna C, Kasprzak J D, Rambaldi R, Salvatori M P, Elhendy A, Cornel J H, Fioretti P M, Roelandt J R

机构信息

Thoraxcentre, University Hospital Rotterdam-Dijkzigt and Erasmus University, Rotterdam, The Netherlands.

出版信息

Eur Heart J. 2000 Oct;21(20):1666-73. doi: 10.1053/euhj.1999.2008.

DOI:10.1053/euhj.1999.2008

PMID:11032693

Abstract

BACKGROUND

Patients with left bundle branch block exhibit abnormal septal motion which may limit the interpretation of stress echocardiograms. This study sought to assess the diagnostic value of dobutamine-atropine stress echocardiography in left bundle branch block patients.

METHODS AND RESULTS

Sixty-four left bundle branch block patients (mean age 59 years, 24 men) with suspected coronary artery disease underwent dobutamine-atropine stress echocardiography and coronary arteriography. Myocardial ischaemia was defined as new or worsening wall thickening abnormalities. Coronary artery disease was quantitatively defined as a diameter stenosis >/=50% in a major epicardial artery. Rest septal motion was normal (apart from the early systolic septal notch) in 34 patients (53%) and abnormal in 30 patients (47%). Rest septal thickening was normal in 32 patients (50%) and abnormal in 32 patients (50%). All seven patients with a QRS duration >/=160 ms and an abnormal QRS axis had abnormal rest septal motion and thickening. Inter-observer agreement for ischaemia was 88%. In all but one patient disagreement was in the septum. For the anterior and posterior circulation, respectively, sensitivity was 60% (9/15) and 67% (8/12), specificity was 94% (46/49) and 98% (51/52), and accuracy was 86% (55/64) and 92% (59/64). Sensitivity for the anterior circulation tended to be better in patients with normal rest septal thickening (83% vs 44%).

CONCLUSIONS

Dobutamine-atropine stress echocardiography has excellent diagnostic specificity in left bundle branch block patients with suspected coronary artery disease. In patients with abnormal rest septal thickening, however, dobutamine-atropine stress echocardiography may lack good sensitivity for detection of coronary artery disease in the anterior circulation. Left bundle branch block patients who potentially most benefit from dobutamine-atropine stress echocardiography may initially be selected by their resting electrocardiogram.

摘要

背景

左束支传导阻滞患者表现出室间隔运动异常，这可能会限制对负荷超声心动图的解读。本研究旨在评估多巴酚丁胺 - 阿托品负荷超声心动图对左束支传导阻滞患者的诊断价值。

方法与结果

64例怀疑患有冠状动脉疾病的左束支传导阻滞患者（平均年龄59岁，24例男性）接受了多巴酚丁胺 - 阿托品负荷超声心动图检查和冠状动脉造影。心肌缺血定义为新出现或加重的室壁增厚异常。冠状动脉疾病定量定义为主要心外膜动脉直径狭窄≥50%。34例患者（53%）静息时室间隔运动正常（除了收缩早期室间隔切迹），30例患者（47%）异常。32例患者（50%）静息时室间隔增厚正常，32例患者（50%）异常。所有7例QRS波时限≥160 ms且QRS电轴异常的患者静息时室间隔运动和增厚均异常。观察者间对缺血的一致性为88%。除1例患者外，所有分歧均在室间隔。在前循环和后循环中，敏感性分别为60%（9/15）和67%（8/12），特异性分别为94%（46/49）和98%（51/52），准确性分别为86%（55/64）和9（59/64）。静息时室间隔增厚正常的患者前循环的敏感性倾向于更高（83%对44%）。

结论

多巴酚丁胺 - 阿托品负荷超声心动图对怀疑患有冠状动脉疾病的左束支传导阻滞患者具有出色的诊断特异性。然而，在静息时室间隔增厚异常的患者中，多巴酚丁胺 - 阿托品负荷超声心动图在前循环中检测冠状动脉疾病可能缺乏良好的敏感性。可能从多巴酚丁胺 - 阿托品负荷超声心动图中获益最大的左束支传导阻滞患者最初可通过其静息心电图进行选择。