Sawada S G, Segar D S, Ryan T, Brown S E, Dohan A M, Williams R, Fineberg N S, Armstrong W F, Feigenbaum H
Department of Medicine, Indiana University School of Medicine, Indianapolis.
Circulation. 1991 May;83(5):1605-14. doi: 10.1161/01.cir.83.5.1605.
Two-dimensional echocardiography performed during dobutamine infusion has been proposed as a potentially useful method for detecting coronary artery disease. However, the safety and diagnostic value of dobutamine stress echocardiography has not been established.
In this study, echocardiograms were recorded during step-wise infusion of dobutamine to a maximum dose of 30 micrograms/kg/min in 103 patients who also underwent quantitative coronary angiography. The echocardiograms were digitally stored and displayed in a format that allowed simultaneous analysis of rest and stress images. Development of a new abnormality in regional function was used as an early end point for the dobutamine infusion. No patient had a symptomatic arrhythmia or complications from stress-induced ischemia. Significant coronary artery disease (greater than or equal to 50% diameter stenosis) was present in 35 of 55 patients who had normal echocardiograms at rest. The sensitivity and specificity of dobutamine-induced wall motion abnormalities for coronary artery disease was 89% (31 of 35) and 85% (17 of 20), respectively. The sensitivity was 81% (17 of 21) in those with one-vessel disease and 100% (14 of 14) in those with multivessel or left main disease. Forty-one of 48 patients with abnormal echocardiograms at baseline had localized rest wall motion abnormalities. Fifteen had coronary artery disease confined to regions that had abnormal rest wall motion, and 26 had disease remote from these regions. Thirteen of 15 patients (87%) without remote disease did not develop remote stress-induced abnormalities, and 21 of 26 (81%) who had remote disease developed corresponding abnormalities.
Echocardiography combined with dobutamine infusion is a safe and accurate method for detecting coronary artery disease and for predicting the extent of disease in those who have localized rest wall motion abnormalities.
多巴酚丁胺输注期间进行的二维超声心动图已被提议作为检测冠状动脉疾病的一种潜在有用方法。然而，多巴酚丁胺负荷超声心动图的安全性和诊断价值尚未确立。
在本研究中，对103例同时接受定量冠状动脉造影的患者，在逐步输注多巴酚丁胺至最大剂量30微克/千克/分钟的过程中记录超声心动图。超声心动图以数字方式存储并以允许同时分析静息和负荷图像的格式显示。区域功能出现新的异常被用作多巴酚丁胺输注的早期终点。没有患者出现症状性心律失常或应激性缺血并发症。在55例静息超声心动图正常的患者中，有35例存在显著冠状动脉疾病（直径狭窄大于或等于50%）。多巴酚丁胺诱发的室壁运动异常对冠状动脉疾病的敏感性和特异性分别为89%（35例中的31例）和85%（20例中的17例）。单支血管病变患者的敏感性为81%（21例中的17例），多支血管或左主干病变患者的敏感性为100%（14例中的14例）。48例基线超声心动图异常的患者中有41例存在局限性静息室壁运动异常。15例冠状动脉疾病局限于静息室壁运动异常区域，26例疾病位于这些区域之外。15例无远处疾病的患者中有13例（87%）未出现远处应激诱发异常，26例有远处疾病的患者中有21例（81%）出现相应异常。
超声心动图联合多巴酚丁胺输注是检测冠状动脉疾病以及预测存在局限性静息室壁运动异常患者疾病范围的一种安全且准确的方法。
