Yang Wei-xian, Yang Yue-jin, Hu Feng-huan, You Shi-jie, Wang Yan-wu, Chen Ji-lin
Division of Coronary Heart Disease, Cardiovascular Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China.
Zhonghua Nei Ke Za Zhi. 2005 Aug;44(8):581-4.
To compare the safety, sensitivity, specificity and accuracy of low dose dobutamine (Dob), isosorbide dinitrate and their combination in stress echocardiography to predict regional movement recovery after coronary revascularization (CRV) in patients with old myocardial infarction (OMI) and severe left ventricular dysfunction.
Fourty patients (mean age 52 +/- 8 years, male 39, female 1) with OMI waiting for CRV with mean left ventricular ejection fraction (LVEF) (39.4 +/- 5.1)%, underwent Dob (3, 5 and 10 microg.kg(-1).min(-1)), isosorbide dinitrate (270 +/- 56) microg/min and their combination (nitrate plus Dob 3, 5 microg.kg(-1).min(-1)) stress echocardiography. Twenty-six patients completed follow-up rest two dimension echocardiography (2DE) (6.8 +/- 2.9) months after CRV.
During Dob 2DE, side effects rates increased by dosage, the drug even induced ischemia at a dosage of 10 microg.kg(-1).min(-1). When Dob was combined with nitrate, no ischemia happened. Among 272 abnormal segments in 26 patients after CRV, 156 segments showed contractile improvement. In Dob 2DE, both the sensitivity (46.8% to 88.6%) and accuracy (64.1% to 77.9%) increased by dosage gradient, while the specificities decreased from 87.1% to 64.2%. When combined with nitrate, the sensitivities and accuracy were higher than either drugs used alone (P < 0.05). The detecting effect in isosorbide dinitrate + Dob 5 microg 2DE was comparable to that of Dob 10 microg.kg(-1).min(-1) 2DE.
In identifying myocardial viability in patients with OMI and severe left ventricular dysfunction, Dob 5-10 microg.kg(-1).min(-1) 2DE have good detecting effects, but could induce ischemia. When nitrate was combined with Dob, no ischemia happened, and the sensitivity and accuracy improved significantly. Isosorbide dinitrate + Dob 5 microg.kg(-1).min(-1) 2DE has identifying effect comparable to Dob 10 microg.kg(-1).min(-1) 2DE.
比较低剂量多巴酚丁胺（Dob）、硝酸异山梨酯及其联合应用在负荷超声心动图检查中预测陈旧性心肌梗死（OMI）合并严重左心室功能不全患者冠状动脉血运重建（CRV）后局部运动恢复情况的安全性、敏感性、特异性和准确性。
40例等待CRV的OMI患者（平均年龄52±8岁，男性39例，女性1例），平均左心室射血分数（LVEF）为（39.4±5.1）%，接受了多巴酚丁胺（3、5和10μg·kg⁻¹·min⁻¹）、硝酸异山梨酯（270±56）μg/min及其联合应用（硝酸酯加多巴酚丁胺3、5μg·kg⁻¹·min⁻¹）负荷超声心动图检查。26例患者在CRV后（6.8±2.9）个月完成了随访静息二维超声心动图（2DE）检查。
在多巴酚丁胺负荷2DE检查期间，副作用发生率随剂量增加而升高，在剂量为10μg·kg⁻¹·min⁻¹时该药物甚至诱发了缺血。当多巴酚丁胺与硝酸酯联合应用时，未发生缺血。26例患者CRV后272个异常节段中，156个节段显示收缩功能改善。在多巴酚丁胺负荷2DE检查中，敏感性（46.8%至88.6%）和准确性（64.1%至77.9%）均随剂量梯度增加，而特异性从87.1%降至64.2%。与硝酸酯联合应用时，敏感性和准确性均高于单独使用任何一种药物（P<0.05）。硝酸异山梨酯+多巴酚丁胺5μg负荷2DE的检测效果与多巴酚丁胺10μg·kg⁻¹·min⁻¹负荷2DE相当。
在识别OMI合并严重左心室功能不全患者的心肌存活性方面，多巴酚丁胺5 - 10μg·kg⁻¹·min⁻¹负荷2DE检测效果良好，但可诱发缺血。当硝酸酯与多巴酚丁胺联合应用时，未发生缺血，且敏感性和准确性显著提高。硝酸异山梨酯+多巴酚丁胺5μg·kg⁻¹·min⁻¹负荷2DE的识别效果与多巴酚丁胺10μg·kg⁻¹·min⁻¹负荷2DE相当。
