Kranidis Athanasios, Bouki Tania, Kostopoulos Konstantinos, Kappos Kostas, Sideris Anthony, Antonellis John, Kardaras Fotis, Margaris Nikos, Lolas Christos, Anthopoulos Lambros
Thisseos 71, Halandri, 152 34 Athens, Greece.
Echocardiography. 1996 Nov;13(6):587-598. doi: 10.1111/j.1540-8175.1996.tb00939.x.
The aim of this study was to assess the significance of the left systolic atrioventricular (AV) plane displacement during low dose dobutamine stress echocardiography (DSE), in predicting the recovery of left ventricular dyssynergies after revascularization. In 30 infarctiers with left ventricular dysfunction scheduled for RE (14 percutaneous transluminal coronary angioplasty and 16 coronary artery bypass graft) and in 25 age- and sex-matched healthy subjects, a DSE, using a 16 ventricular segment model and a four-grade scoring system for the assessment of regional wall motion of the left ventricle was performed. Prior and during DSE, the left systolic AV plane displacement was recorded from the apical four- and two-chamber views, by M-mode echo, at four left ventricular sites, corresponding to the septal, lateral, anterior, and inferior walls, both in patients and controls. The study was repeated in all patients 101 +/- 14 days after successful revascularization. Healthy subjects showed a significant increase of left systolic AV plane displacement at all left ventricular sites during dobutamine infusion (DI) (P < 0.001). Patients also exhibited a significant maximum increase of left systolic AV plane displacement during DSE only in the dyssynergic sites with functional improvement in the postrevascularization echocardiogram (P < 0.001). In the remaining dyssynergic sites, without functional improvement after revascularization, the left systolic AV plane displacement did not change (P > 0.05). Selecting a maximum LAVPD increase of >2 mm at any site of the left ventricule to predict recovery of the regional ventricular dyssynergies, results in a sensitivity of 91%, specificity of 83%, positive predictive value of 88%, and negative predictive value of 87%. When two-dimensional DSE was used for the detection of reversible dysfunction, sensitivity and specificity were found to be 81.5% and 87.5%, respectively, while the positive and negative predictive values were 90% and 78%, respectively. When the two methods were in agreement the sensitivity was 90%, the specificity 100%, and the positive and negative predictive values were 100% and 84.2%, respectively. The assessment of left systolic AV plane displacement during DI constitutes a new, simple, and accurate method in the prediction of left ventricular dyssynergy recovery after revascularization. The combination of this method and two-dimensional DSE are basic predictor markers of viability of dysfunctional myocardium. (ECHOCARDIOGRAPHY, Volume 13, November 1996)
本研究旨在评估低剂量多巴酚丁胺负荷超声心动图（DSE）期间左心室收缩期房室平面位移在预测血运重建后左心室协同失调恢复方面的意义。对30例计划进行血运重建（14例经皮腔内冠状动脉成形术和16例冠状动脉旁路移植术）的左心室功能障碍梗死患者以及25例年龄和性别匹配的健康受试者，采用16节段心室模型和四级评分系统对左心室局部室壁运动进行评估，进行了DSE检查。在DSE检查前及检查期间，通过M型超声心动图从心尖四腔和两腔视图记录患者和对照组左心室四个部位（对应于室间隔、侧壁、前壁和下壁）的左心室收缩期房室平面位移。在所有患者成功血运重建后101±14天重复此项研究。健康受试者在多巴酚丁胺输注（DI）期间左心室所有部位的左心室收缩期房室平面位移均显著增加（P<0.001）。患者仅在血运重建后超声心动图显示功能改善的协同失调部位，在DSE期间左心室收缩期房室平面位移有显著最大增加（P<0.001）。在血运重建后无功能改善的其余协同失调部位，左心室收缩期房室平面位移未改变（P>0.05）。选择左心室任何部位最大左房室平面位移增加>2mm来预测局部心室协同失调的恢复，其敏感性为91%，特异性为83%，阳性预测值为88%，阴性预测值为87%。当使用二维DSE检测可逆性功能障碍时，敏感性和特异性分别为81.5%和87.5%，而阳性和阴性预测值分别为90%和78%。当两种方法结果一致时，敏感性为90%，特异性为100%，阳性和阴性预测值分别为100%和84.2%。评估DI期间左心室收缩期房室平面位移是预测血运重建后左心室协同失调恢复的一种新的、简单且准确的方法。该方法与二维DSE的联合应用是功能失调心肌存活的基本预测指标。（《超声心动图》，第13卷，1996年11月）
