Dahan Michel, Viron Béatrice M, Poiseau Elisabeth, Kolta Amir M, Aubry Nicolas, Paillole Catherine, Pessione Fabienne, Bonnin François, Logeart Damien, Gourgon René, Mignon Françoise E
Nephrology Department, Bichat Hospital, Paris, France.
Am J Kidney Dis. 2002 Oct;40(4):737-44. doi: 10.1053/ajkd.2002.35684.
Stress nuclear imaging is the noninvasive technique currently used to detect coronary artery disease (CAD) in dialysis patients. Stress echocardiography is recognized as an alternative to stress nuclear imaging for the general population. The aim of this study is to assess the diagnostic accuracy of stress echocardiography for detecting myocardial ischemia in hemodialysis patients.
Stress echocardiography and stress technetium-99m-tetrofosmin (Myoview; Amersham International Plc) imaging were performed simultaneously for 66 asymptomatic hemodialysis patients in a single session, using a combination of high-dose dipyridamole and symptom-limited exercise. Coronary angiography was performed in 44 patients with at least one abnormal noninvasive test result or who were considered high-risk despite normal noninvasive test results.
Results for stress echocardiography were abnormal in 15 patients (22%); stress Myoview, in 14 patients (21%); and coronary angiography, in 12 patients (18%). The sensitivity of stress echocardiography for detecting myocardial ischemia (defined as stress Myoview defect) was 86%; specificity, 94%; positive predictive value, 80%; negative predictive value, 96%; and overall accuracy, 92%. The sensitivity of stress echocardiography for detecting CAD (defined as abnormal coronary angiography result) was 83%; specificity, 84%; positive predictive value, 67%; negative predictive value, 93%; and overall accuracy, 84%. Stress echocardiography and stress Myoview did not differ significantly in overall accuracy for detecting CAD (84% versus 91%; P = not significant).
In hemodialysis patients, combined dipyridamole-exercise echocardiography is an accurate method to detect both myocardial ischemia and CAD and represents an alternative to stress nuclear imaging.
负荷核素成像目前是用于检测透析患者冠状动脉疾病（CAD）的非侵入性技术。负荷超声心动图被认为是普通人群中负荷核素成像的替代方法。本研究的目的是评估负荷超声心动图检测血液透析患者心肌缺血的诊断准确性。
对66例无症状血液透析患者在同一时段同时进行负荷超声心动图和负荷99m锝-替曲膦（Myoview；安万特国际公司）成像，采用大剂量双嘧达莫和症状限制性运动相结合的方法。对44例至少一项非侵入性检查结果异常或尽管非侵入性检查结果正常但被认为是高危的患者进行冠状动脉造影。
15例患者（22%）的负荷超声心动图结果异常；14例患者（21%）的负荷Myoview结果异常；12例患者（18%）的冠状动脉造影结果异常。负荷超声心动图检测心肌缺血（定义为负荷Myoview缺损）的敏感性为86%；特异性为94%；阳性预测值为80%；阴性预测值为96%；总体准确性为92%。负荷超声心动图检测CAD（定义为冠状动脉造影结果异常）的敏感性为83%；特异性为84%；阳性预测值为67%；阴性预测值为93%；总体准确性为84%。负荷超声心动图和负荷Myoview在检测CAD的总体准确性方面无显著差异（84%对91%；P = 无显著性）。
在血液透析患者中，双嘧达莫-运动负荷超声心动图联合检查是检测心肌缺血和CAD的准确方法，是负荷核素成像的替代方法。
