Salustri A, Fioretti P M, McNeill A J, Pozzoli M M, Roelandt J R
Thoraxcenter, University Hospital Rotterdam-Dijkzigt, The Netherlands.
Eur Heart J. 1992 Oct;13(10):1356-62. doi: 10.1093/oxfordjournals.eurheartj.a060066.
The objective of this study was to relate regional wall motion abnormalities assessed by dobutamine and dipyridamole stress echocardiography to quantitative measurements of coronary artery stenoses in consecutive patients referred for coronary angiography, and to compare haemodynamic effects of and complications related to the two agents. Patients underwent stress echoes on separate days in random sequence and had coronary angiography within 3 days of stress echocardiography. Echocardiograms were assessed by two investigators unaware of the patients' coronary anatomy. Coronary angiograms were also assessed quantitatively using the computer-assisted Cardiovascular Angiography Analysis System. There were 46 consecutive patients referred for coronary angiography; 28 were using beta-antagonists. Main outcome measures were sensitivity and specificity for dobutamine and dipyridamole stress echocardiography for detection of coronary artery disease (wall motion abnormalities at rest or stress) and myocardial ischaemia (stress induced new wall motion abnormalities). Sensitivity for the detection of myocardial ischaemia was found to be 57% for dobutamine and 64% for dipyridamole. Specificities were 78% and 89% respectively. Sensitivities for detection of coronary artery disease (lesion > or = 50% diameter stenosis) was 79% for dobutamine and 82% for dipyridamole; specificities were 78% and 89% respectively. These differences between the two agents are not significant. There were no severe side effects with either agent. Mean heart rate rose significantly with both tests but was higher with dobutamine; mean systolic blood pressure rose with dobutamine and fell with dipyridamole. It was concluded that dobutamine and dipyridamole stress echocardiography have similar sensitivities and specificities for detection of myocardial ischaemia and coronary artery disease although the haemodynamic effects of the two agents are different. Both are free from serious complications.
本研究的目的是将通过多巴酚丁胺和双嘧达莫负荷超声心动图评估的局部室壁运动异常与连续接受冠状动脉造影的患者冠状动脉狭窄的定量测量相关联，并比较这两种药物的血流动力学效应及相关并发症。患者在不同日期按随机顺序接受负荷超声心动图检查，并在负荷超声心动图检查后3天内接受冠状动脉造影。超声心动图由两名不了解患者冠状动脉解剖结构的研究人员进行评估。冠状动脉造影也使用计算机辅助心血管造影分析系统进行定量评估。连续有46例患者接受冠状动脉造影；28例正在使用β受体阻滞剂。主要观察指标是多巴酚丁胺和双嘧达莫负荷超声心动图检测冠状动脉疾病（静息或负荷时的室壁运动异常）和心肌缺血（负荷诱发的新的室壁运动异常）的敏感性和特异性。发现多巴酚丁胺检测心肌缺血的敏感性为57%，双嘧达莫为64%。特异性分别为78%和89%。检测冠状动脉疾病（病变直径狭窄≥50%）的敏感性，多巴酚丁胺为79%，双嘧达莫为82%；特异性分别为78%和89%。这两种药物之间的这些差异无统计学意义。两种药物均未出现严重副作用。两种检查时平均心率均显著升高，但多巴酚丁胺检查时更高；多巴酚丁胺检查时平均收缩压升高，双嘧达莫检查时平均收缩压降低。得出的结论是，多巴酚丁胺和双嘧达莫负荷超声心动图在检测心肌缺血和冠状动脉疾病方面具有相似的敏感性和特异性，尽管两种药物的血流动力学效应不同。两者均无严重并发症。
