多巴酚丁胺负荷超声心动图：加拿大一个中心的初步经验。

Dobutamine stress echocardiography: initial experience of a Canadian centre.

作者信息

Epstein M, Gin K, Sterns L, Pollick C

机构信息

Department of Medicine, Vancouver General Hospital, British Columbia.

出版信息

Can J Cardiol. 1992 Apr;8(3):273-9.

PMID:1576561

Abstract

OBJECTIVE

To investigate the diagnostic accuracy, electrocardiogram and hemodynamic effects and safety of dobutamine stress echocardiography.

SUBJECTS

Sixty-one patients with suspected coronary artery disease. All patients underwent coronary arteriography.

MAIN RESULTS

The sensitivity of dobutamine stress echocardiography in diagnosis of coronary artery disease in the whole group was 91%. In patients with left anterior descending it was 97%; right 85%; circumflex 76%; three vessel 100%; two vessel 95%; single vessel 77%. Specificity, positive predictive value and accuracy of dobutamine stress echocardiography in diagnosis of coronary disease (whole group) was 57, 94 and 87%, respectively. ST depression of more than 1 mm occurred in 11 patients, ST elevation of more than 1 mm in three patients, T wave inversion in one and T normalization in nine. Significant differences of the effects of beta-blockers were noted on the peak effects of dobutamine as follows: heart rate increase of 46 +/- 22 versus 20 +/- 13 beats/min (P less than 0.0001); systolic pressure increase of 4 +/- 26 versus 22 +/- 19 mmHg (P less than 0.01); diastolic pressure decrease of 18 +/- 16 versus 10 +/- 12 mmHg (P less than 0.03) for patients without or with beta-blockers, respectively. Unifocal ventricular premature beats were noted in 10 patients, atrial premature beats in five and ventricular couplets in one. Angina occurred in 11 patients. Atypical chest pain occurred in seven patients, tingling in 11 and nausea in four. Thirty-six patients were totally asymptomatic.

CONCLUSIONS

In this population with high prevalence (85%) of coronary artery disease, dobutamine stress echocardiography had high sensitivity and positive predictive value for coronary disease detection particularly in patients with left anterior descending or three vessel disease. The specificity and accuracy were not as good, but this may reflect the small number of normal patients. Dobutamine was well tolerated and conveniently administered.

摘要

目的

探讨多巴酚丁胺负荷超声心动图的诊断准确性、心电图及血流动力学效应和安全性。

研究对象

61例疑似冠心病患者。所有患者均接受了冠状动脉造影。

主要结果

多巴酚丁胺负荷超声心动图对全组冠心病诊断的敏感性为91%。在左前降支病变患者中为97%；右冠状动脉病变患者中为85%；回旋支病变患者中为76%；三支血管病变患者中为100%；两支血管病变患者中为95%；单支血管病变患者中为77%。多巴酚丁胺负荷超声心动图对冠心病诊断（全组）的特异性、阳性预测值和准确性分别为57%、94%和87%。11例患者出现ST段压低超过1mm，3例患者出现ST段抬高超过1mm，1例患者出现T波倒置，9例患者出现T波正常化。β受体阻滞剂对多巴酚丁胺峰值效应的影响存在显著差异，具体如下：未使用或使用β受体阻滞剂的患者，心率增加分别为46±22次/分钟和20±13次/分钟（P<0.0001）；收缩压升高分别为4±26mmHg和22±19mmHg（P<0.01）；舒张压降低分别为18±16mmHg和10±12mmHg（P<0.03）。10例患者出现单源性室性早搏，5例患者出现房性早搏，1例患者出现室性成对早搏。11例患者发生心绞痛。7例患者出现非典型胸痛，11例患者出现刺痛，4例患者出现恶心。36例患者完全无症状。