Vitarelli A, Conde Y, Luzzi M F, Benedetto G D, Giubilei R, Leone T, Cimino E
Department of Cardiology, La Sapienza University, Rome, Italy.
J Investig Med. 2001 Nov;49(6):534-43. doi: 10.2310/6650.2001.33630.
Transesophageal dobutamine stress echocardiography (T-DSE) has been shown to be a sensitive and specific technique for the detection of myocardial ischemia. A major limitation of echocardiographic study interpretation, however, is the subjective visual analysis of endocardial motion and wall thickening, which is only semiquantitative.
To analyze whether T-DSE with the use or tissue Doppler imaging (TDI) during graded dobutamine infusion may be useful to detect and quantify stress-induced myocardial ischemia by changes in myocardial velocities, 70 patients undergoing coronary arteriography were studied with T-DSE and TDI. Midesophageal and transgastric short- and long-axis images were obtained at each level of dobutamine infusion. T-DSE was successful in 67 patients (96%). Baseline resting pulsed and color peak systolic (S) and early diastolic (E) velocities of the anterior, septal, lateral, and inferior walls were examined.
Pulsed and color TDI correlated well at rest and after stress. Fifteen patients had a normal response to dobutamine, and 52 patients had inducible ischemia by two-dimensional criteria. In the normal group, there was a significant dose-dependent increase in S and E velocities. Compared with those in the normal group, patients with coronary artery disease (CAD) had lower resting S and E velocities and blunted S wave increase or E wave decrease during DSE.
T-DSE with TDI is a feasible and accurate test for the quantitative assessment of patients with CAD who have impaired augmentation of systolic and diastolic myocardial velocities during dobutamine infusion.
经食管多巴酚丁胺负荷超声心动图（T-DSE）已被证明是检测心肌缺血的一种敏感且特异的技术。然而，超声心动图研究解读的一个主要局限是对心内膜运动和室壁增厚的主观视觉分析，这种分析只是半定量的。
为分析在多巴酚丁胺分级输注过程中使用组织多普勒成像（TDI）的T-DSE是否有助于通过心肌速度变化检测和量化应激诱导的心肌缺血，对70例接受冠状动脉造影的患者进行了T-DSE和TDI研究。在多巴酚丁胺输注的每个水平获取食管中段和经胃短轴及长轴图像。67例患者（96%）T-DSE检查成功。检测了前壁、室间隔、侧壁和下壁的基线静息脉冲波和彩色峰值收缩期（S）及舒张早期（E）速度。
静息和应激后脉冲波和彩色TDI相关性良好。15例患者对多巴酚丁胺反应正常，52例患者根据二维标准存在可诱导的缺血。在正常组中，S和E速度有显著的剂量依赖性增加。与正常组相比，冠状动脉疾病（CAD）患者静息时S和E速度较低，多巴酚丁胺负荷超声心动图检查期间S波增加或E波降低不明显。
对于多巴酚丁胺输注期间收缩期和舒张期心肌速度增强受损的CAD患者，T-DSE联合TDI是一种可行且准确的定量评估检测方法。
