Mazeika P, Nihoyannopoulos P, Joshi J, Oakley C M
Department of Medicine (Clinical Cardiology), Hammersmith Hospital, London, United Kingdom.
Am J Cardiol. 1991 Aug 15;68(5):478-84. doi: 10.1016/0002-9149(91)90782-g.
Doppler assessment of left ventricular filling and ejection during dipyridamole stress may supplement wall motion analysis for detection of myocardial ischemia and coronary artery disease (CAD). Thirty-four patients taking no cardioactive therapy were studied using intravenous dipyridamole (0.6 mg/kg) during 2-dimensional and pulsed Doppler echocardiography. Twelve patients had normal coronary arteries (group 1) and the remainder, who had significant CAD, were divided into groups 2 (n = 11) and 3 (n = 11). Only subjects in group 2 developed myocardial ischemia manifest as reversible regional asynergy and ST-segment depression. Heart rate increased (16 +/- 9 beats/min, p less than 0.01) and mean blood pressure decreased (-5 +/- 8 mm Hg, p = not significant) uniformly across groups. Exaggerated hyperkinesia of normally contracting wall segments was the common response to dipyridamole infusion in patients with CAD. The respective mean percent changes in peak early diastolic velocity, peak atrial velocity, their ratio and ejection peak velocity, and mean acceleration for groups 1 (20, 42, -13, 20 and 23%), 2 (22, 32, -2, 10 and 14%) and 3 (23, 33, -6, 16 and 18%) were similar. Comparisons between normal patients and those with CAD and between groups 2 and 3 revealed no significant differences in the effect of dipyridamole on any variable. However, a decrease in both peak velocity and mean acceleration of left ventricular ejection was seen in 3 of 4 group 2 patients who developed severe ischemia. Dipyridamole-Doppler echocardiography is insensitive for detection of CAD and appears unable to identify myocardial ischemia unless this is severe. Hemodynamic changes and compensatory wall motion induced by dipyridamole may explain these findings.
双嘧达莫负荷试验期间对左心室充盈和射血进行多普勒评估，可能有助于补充壁运动分析，以检测心肌缺血和冠状动脉疾病（CAD）。对34例未接受心脏活性药物治疗的患者在二维和脉冲多普勒超声心动图检查期间静脉注射双嘧达莫（0.6mg/kg）进行研究。12例患者冠状动脉正常（第1组），其余患有严重CAD的患者分为第2组（n = 11）和第3组（n = 11）。只有第2组的受试者出现心肌缺血，表现为可逆性局部运动失调和ST段压低。各组心率均升高（16±9次/分钟，p<0.01），平均血压均下降（-5±8mmHg，p无统计学意义）。CAD患者对双嘧达莫输注的常见反应是正常收缩壁段出现过度运动增强。第1组（20%、42%、-13%、20%和23%）、第2组（22%、32%、-2%、10%和14%）和第3组（23%、33%、-6%、16%和18%）的早期舒张期峰值速度、心房峰值速度、它们的比值、射血峰值速度以及平均加速度的各自平均百分比变化相似。正常患者与CAD患者之间以及第2组和第3组之间的比较显示，双嘧达莫对任何变量的影响均无显著差异。然而，在出现严重缺血的第2组4例患者中的3例中，观察到左心室射血的峰值速度和平均加速度均降低。双嘧达莫-多普勒超声心动图对CAD的检测不敏感，除非心肌缺血严重，否则似乎无法识别。双嘧达莫引起的血流动力学变化和代偿性壁运动可能解释了这些发现。
