Yuda Satoshi, Fang Zhi You, Leano Rodel, Marwick Thomas H
University of Queensland, Brisbane, Australia
J Am Soc Echocardiogr. 2004 May;17(5):448-53. doi: 10.1016/j.echo.2004.01.001.
False-negative interpretations of dobutamine stress echocardiography (DSE) may be associated with reduced wall stress. Using measurements of contraction, we sought whether these segments were actually ischemic but unrecognized or showed normal contraction.
We studied 48 patients (29 men; mean age 60 +/- 10 years) with normal regional function on the basis of standard qualitative interpretation of DSE. At coronary angiography within 6 months of DSE, 32 were identified as having true-negative and 16 as having false-negative results of DSE. Three apical views were used to measure regional function with color Doppler tissue, integrated backscatter, and strain rate imaging. Cyclic variation of integrated backscatter was measured in 16 segments, and strain rate and peak systolic strain was calculated in 6 walls at rest and peak stress.
Segments with false-negative results of DSE were divided into 2 groups with and without low wall stress according to previously published cut-off values. Age, sex, left ventricular mass, left ventricular geometric pattern, and peak workload were not significantly different between patients with true- and false-negative results of DSE. Importantly, no significant differences in cyclic variation and strain parameters at rest and peak stress were found among segments with true- and false-negative results of DSE with and without low wall stress. Stenosis severity had no influence on cyclic variation and strain parameters at peak stress.
False-negative results of DSE reflect lack of ischemia rather than underinterpretation of regional left ventricular function. Quantitative markers are unlikely to increase the sensitivity of DSE.
多巴酚丁胺负荷超声心动图(DSE)的假阴性解读可能与壁应力降低有关。通过收缩测量,我们探究这些节段是实际上存在缺血但未被识别,还是显示正常收缩。
我们基于DSE的标准定性解读,研究了48例(29例男性;平均年龄60±10岁)局部功能正常的患者。在DSE后6个月内进行冠状动脉造影,其中32例被确定为DSE真阴性结果,16例为假阴性结果。使用三个心尖视图,通过彩色多普勒组织成像、背向散射积分和应变率成像来测量局部功能。在16个节段中测量背向散射积分的周期性变化,并在静息和负荷峰值时计算6个心肌壁的应变率和收缩期峰值应变。
根据先前公布的临界值,将DSE假阴性结果的节段分为有和没有低壁应力的两组。DSE真阴性和假阴性结果的患者之间,年龄、性别、左心室质量、左心室几何形态和峰值负荷没有显著差异。重要的是,在有和没有低壁应力的DSE真阴性和假阴性结果的节段之间,静息和负荷峰值时的周期性变化和应变参数没有显著差异。狭窄严重程度对负荷峰值时的周期性变化和应变参数没有影响。
DSE的假阴性结果反映的是缺乏缺血,而非对局部左心室功能解读不足。定量指标不太可能提高DSE的敏感性。