Heinicke N, Benesch B, Kaiser T, Debl K, Segmüller M, Schönberger J, Marienhagen J, Eilles C, Riegger G A J, Holmer S, Luchner A
Klinik und Poliklinik für Innere Medizin II, University of Regensburg, 93042, Regensburg, Germany.
Clin Res Cardiol. 2006 Dec;95(12):650-6. doi: 10.1007/s00392-006-0443-2. Epub 2006 Sep 28.
In the diagnosis of coronary artery disease (CAD) with Dobutamine Stress Echocardiography (DSE), regional wall motion abnormalities (RWMA) are assumed to indicate a perfusion deficit.
For a more particular examination of RWMAs, we compared simultaneous echo-contrast (Optisone)-enhanced DSE (0-40 microg/kg Dobutamine, 16-segment- model) and MiBi-SPECT in a prospective double-blinded study design in 69 non-selected consecutive patients (44 male, 25 female, age 64+/-12 years). Additionally, all patients were examined by coronary-angiography. The prevalence of significant CAD (stenosis >50% lumen diameter) was 52%. DSE had a sensitivity of 78% and a specificity of 66% for the detection of significant CAD with a positive and negative predictive value of 72 and 73%, respectively. Among 28 patients with significant CAD and positive DSE study (true positive), 78% displayed a corresponding perfusion deficit in MiBi-SPECT. Among 11 patients with a positive DSE study but no current significant coronary stenosis (false positive), 82% showed stress-induced RWMAs in the inferior/posterior region, 73% displayed left ventricular hypertrophy, 54% resting-ECG abnormalities and 45% resting-RWMA (3 previous MI, 2 previous CABG surgery). Among 8 patients with negative DSE study but significant coronary stenosis (false negative), 75% had a stenosis of the LCX, 63% displayed resting- WMA, 63% displayed left bundle branch block or ST-segment depression, 50% displayed only peripheral coronary stenosis, and DSE visualization was suboptimal in 38%.
This prospective study in non-selected patients shows that the majority of RWMAs in DSE are matched to a perfusion deficit detectable by nuclear imaging. Nevertheless, pre-existing cardiac abnormalities may also lead to stress-induced RWMA not associated with a perfusion deficit or mask a perfusion deficit upon DSE. Particularly in patients with LV hypertrophy, resting-RWMA, bundle branch block or ST segment depression, the predictive value of DSE may, therefore, be limited.
在使用多巴酚丁胺负荷超声心动图（DSE）诊断冠心病（CAD）时，局部室壁运动异常（RWMA）被认为提示灌注不足。
为了更详细地研究RWMA，我们在一项前瞻性双盲研究设计中，对69例未经选择的连续患者（44例男性，25例女性，年龄64±12岁）进行了同步超声造影（Optisone）增强DSE（0 - 40μg/kg多巴酚丁胺，16节段模型）和心肌灌注SPECT（MiBi - SPECT）检查。此外，所有患者均接受了冠状动脉造影检查。显著CAD（管腔直径狭窄>50%）的患病率为52%。DSE检测显著CAD的敏感性为78%，特异性为66%，阳性预测值和阴性预测值分别为72%和73%。在28例DSE检查阳性且患有显著CAD的患者（真阳性）中，78%在MiBi - SPECT中显示出相应的灌注不足。在11例DSE检查阳性但目前无显著冠状动脉狭窄的患者（假阳性）中，82%在下壁/后壁区域显示有应激诱导的RWMA，73%有左心室肥厚，54%有静息心电图异常，45%有静息RWMA（3例既往心肌梗死，2例既往冠状动脉搭桥手术）。在8例DSE检查阴性但有显著冠状动脉狭窄的患者（假阴性）中，75%为左旋支狭窄，63%有静息室壁运动异常，63%有左束支传导阻滞或ST段压低，50%仅有外周冠状动脉狭窄，38%的DSE图像质量欠佳。
这项针对未经选择患者的前瞻性研究表明，DSE中大多数RWMA与核成像可检测到的灌注不足相匹配。然而，既往存在的心脏异常也可能导致应激诱导的RWMA与灌注不足无关，或在DSE检查时掩盖灌注不足。因此，特别是在患有左心室肥厚、静息RWMA、束支传导阻滞或ST段压低的患者中，DSE的预测价值可能有限。
