Mertes H, Erbel R, Nixdorff U, Mohr-Kahaly S, Wölfinger D, Meyer J
II. Medizinische Klinik und Poliklinik der Johannes-Gutenberg-Universität Mainz.
Herz. 1991 Oct;16(5):355-66.
Prevalence of coronary artery disease requires sensitive diagnostic methods for screening and follow-up. The sensitivity of stress-ECG is low, 201-thallium scintigraphy is more sensitive but has the disadvantages of radiation and costs. Improved echocardiographic resolution with better identification of endocardial border as well as digital imaging technique have increased the interest in stress echocardiography as a diagnostic tool in coronary artery disease since a decade ago the clinical usefulness of stress echocardiography has been demonstrated. For stress echocardiography a semisupine bicycle position for continuous recording of echocardiographic images from the apical position in the two-chamber- and RAO-view was developed. Echocardiographic images were digitized with a frame rate of 30/s and stored on optical discs with a storage capacity of 1 Gbyte. Rest and exercise images were analysed simultaneously for newly-occurring wall motion abnormalities or deterioration of already present hypokinesia or extension of existing wall motion abnormalities. Segmental wall motion was scored according to the scheme in Figure 2. In addition end-diastolic, end-systolic volume, and ejection fraction were calculated. In a patient population of 150, 30 female and 120 male, age 56.6 +/- 8.3 years, we could confirm the results reported by other working groups and demonstrate a high sensitivity in the diagnosis of single vessel disease. Our technique with the patient cycling in semi-supine position allows continuous echocardiographic registration during exercise and offers adequate image quality. The mean workload at peak stress was 127 +/- 30 watts, the maximal heart rate 137 +/- 18 bpm. Digital cine-loop imaging allowed evaluation of the examinations in about 90% of the cases. The sensitivity in the whole study group was 87%, the specificity 80%. Under full antianginal medication, 43% of the patients developed angina pectoris during exercise and 58% had a positive stress-ECG. The sensitivity in single-vessel coronary artery disease was 93% for the left anterior descending, 80% for the left circumflex, and 83% for the right coronary artery. These results in single-vessel disease were superior compared to findings of other authors using different techniques of stress echocardiography. In addition to the qualitative analysis, quantitative measurement of end-systolic volume and ejection fraction seems to be important. We found a significantly more pronounced decrease of ejection fraction at peak exercise in patients with multivessel disease compared to those with single-vessel disease. In single-vessel disease ejection fraction was 61 +/- 12% at rest and 57 +/- 17% during exercise, this difference was not significant.(ABSTRACT TRUNCATED AT 400 WORDS)
冠心病的患病率需要敏感的诊断方法用于筛查和随访。运动心电图的敏感性较低，铊-201心肌显像更敏感，但存在辐射和费用方面的缺点。自十年前应力超声心动图的临床实用性得到证实以来，随着超声心动图分辨率的提高以及心内膜边界识别能力的增强，再加上数字成像技术，人们对其作为冠心病诊断工具的兴趣日益增加。对于应力超声心动图，开发了一种半仰卧位骑单车姿势，以便从心尖位置在双腔和右前斜位连续记录超声心动图图像。超声心动图图像以30帧/秒的帧率数字化，并存储在容量为1GB的光盘上。同时分析静息和运动图像，以观察新出现的室壁运动异常、已存在的运动减弱是否恶化或现有室壁运动异常是否扩展。根据图2中的方案对节段性室壁运动进行评分。此外，还计算舒张末期、收缩末期容积和射血分数。在150例患者中，30例女性，120例男性，年龄56.6±8.3岁，我们能够证实其他研究小组报告的结果，并证明在单支血管疾病诊断中具有高敏感性。我们让患者半仰卧位骑车的技术能够在运动期间进行连续超声心动图记录，并提供足够的图像质量。峰值应力时的平均工作量为127±30瓦，最大心率为137±18次/分钟。数字电影环形成像使约90%的病例能够进行检查评估。整个研究组的敏感性为87%，特异性为80%。在充分使用抗心绞痛药物的情况下，43%的患者在运动期间出现心绞痛，58%的患者运动心电图呈阳性。在单支血管冠状动脉疾病中，左前降支的敏感性为93%，左旋支为80%，右冠状动脉为83%。与使用不同应力超声心动图技术的其他作者的研究结果相比，单支血管疾病的这些结果更优。除了定性分析外，收缩末期容积和射血分数的定量测量似乎也很重要。我们发现，与单支血管疾病患者相比，多支血管疾病患者在运动峰值时射血分数的下降更为明显。在单支血管疾病中，静息时射血分数为61±12%，运动时为57±17%，这种差异不显著。（摘要截选至400字）
