Vogel R, Indermühle A, Meier P, Seiler C
Bern University Hospital and University of Bern, Switzerland, Bern, Switzerland.
Heart. 2009 Mar;95(5):377-84. doi: 10.1136/hrt.2007.134577. Epub 2008 Aug 12.
To test whether quantitative stress echocardiography using contrast-based myocardial blood flow (MBF, ml x min(-1) x g(-1)) measurements can detect coronary artery disease in humans.
48 patients eligible for pharmacological stress testing by myocardial contrast echocardiography (MCE) and willing to undergo subsequent coronary angiography were prospectively enrolled in the study. Baseline and adenosine-induced (140 microg x kg(-1) x min(-1)) hyperaemic MBF was analysed according to a three-coronary-artery-territory model. Vascular territories were categorised into three groups with increasing stenosis severity defined as percentage diameter reduction by quantitative coronary angiography.
Myocardial blood flow reserve (MBFR)-that is, the ratio of hyperaemic to baseline MBF, was obtained in 128 (89%) territories. Mean (SD) baseline MBF was 1.073 (0.395) ml x min(-1) x g(-1) and did not differ between territories supplied by coronary arteries with mild (<50% stenosis), moderate (50%-74% stenosis) or severe (>or=75% stenosis) disease. Mean (SD) hyperaemic MBF and MBFR were 2.509 (1.078) ml x min(-1) x g(-1) and 2.54 (1.03), respectively, and decreased linearly (r2 = 0.21 and r2 = 0.39) with stenosis severity. ROC analysis revealed that a territorial MBFR <1.94 detected >or=50% stenosis with 89% sensitivity and 92% specificity.
Quantitative stress testing based on MBF measurements derived from contrast echocardiography is a new method for the non-invasive and reliable assessment of coronary artery disease in humans.
检测基于心肌血流（MBF，ml·min⁻¹·g⁻¹）测量的定量负荷超声心动图能否检测人类冠状动脉疾病。
48例符合心肌对比超声心动图（MCE）药物负荷试验条件且愿意接受后续冠状动脉造影的患者前瞻性纳入本研究。根据三支冠状动脉供血区域模型分析基线和腺苷诱导（140μg·kg⁻¹·min⁻¹）充血状态下的MBF。血管区域分为三组，狭窄严重程度增加，通过定量冠状动脉造影将其定义为直径减少百分比。
在128个（89%）区域获得了心肌血流储备（MBFR），即充血状态下与基线MBF的比值。平均（标准差）基线MBF为1.073（0.395）ml·min⁻¹·g⁻¹，在轻度（<50%狭窄）、中度（50%-74%狭窄）或重度（≥75%狭窄）冠状动脉疾病供血区域之间无差异。平均（标准差）充血状态下的MBF和MBFR分别为2.509（1.078）ml·min⁻¹·g⁻¹和2.54（1.03），并随狭窄严重程度呈线性下降（r² = 0.21和r² = 0.39）。ROC分析显示，区域MBFR<1.94检测≥50%狭窄的敏感性为89%，特异性为92%。
基于对比超声心动图测量MBF的定量负荷试验是一种用于人类冠状动脉疾病无创且可靠评估的新方法。
