Aboukhoudir Falah, Rekik Sofiene, Andrieu Stephane, Cheggour Saida, Pansieri Michel, Metge Marc, Barnay Pierre, Faugier Jean Paul, Schouvey Sylvie, Quaino Gonzalo, Unal Clement, Gonzalez Stéphanie, Hirsch Jean Lou
Cardiology Department, Avignon Hospital Center, Avignon, France.
Eur J Echocardiogr. 2009 Jun;10(4):556-61. doi: 10.1093/ejechocard/jep004. Epub 2009 Feb 6.
The aim of this article was to assess whether abnormal dobutamine stress echocardiography (DSE) can be due to a dobutamine-induced coronary spasm in patients with angiographically documented vasospastic coronary arteries.
Between January 2004 and April 2008, we prospectively evaluated all patients with known or suspected coronary artery disease (CAD) referred to the echocardiography laboratory for dobutamine stress tests (6061 examinations). Those with abnormal DSE underwent coronary angiogram with a systematic methylergometrine intracoronary injection in the case of absence of significant coronary stenosis or spontaneous occlusive coronary spasm. Patients who had spontaneous occlusive coronary spasm or positive methylergometrine test, but no significant stenoses, were ultimately included in this study. About 581 patients had abnormal DSE, among them only 20 (3.4%) fulfilled the inclusion criteria. There were 15 males and 5 females, and mean age was 64.35 years (range 52-85); 8 patients had a known history of CAD and all of them had at least two established cardiovascular risk factors. The culprit vessel was the left anterior descending artery in 10 cases (50%), right coronary artery in 8 cases (40%), and left circumflex in 2 cases (10%). There was a systematic correspondence between the culprit arteries and dobutamine-induced wall motion abnormality territories. No complications occurred during examination or during the provocation test. All the patients were discharged with a calcium channel blocker and were doing well after 13 months of mean follow-up.
Coronary artery spasm can be induced at DSE, but is a rare finding; it could, though, be clinically relevant as it may partly explain some erroneously labelled 'false-positive' examinations. Methylergometrine provocation test is a safe and advisable approach in such situations.
本文旨在评估在血管造影证实存在血管痉挛性冠状动脉的患者中，异常的多巴酚丁胺负荷超声心动图（DSE）是否由多巴酚丁胺诱发的冠状动脉痉挛所致。
在2004年1月至2008年4月期间，我们对所有因多巴酚丁胺负荷试验而被转诊至超声心动图实验室的已知或疑似冠状动脉疾病（CAD）患者进行了前瞻性评估（共6061次检查）。DSE异常的患者在无明显冠状动脉狭窄或自发性闭塞性冠状动脉痉挛的情况下接受了冠状动脉造影及系统性麦角新碱冠状动脉内注射。最终纳入本研究的患者为那些有自发性闭塞性冠状动脉痉挛或麦角新碱试验阳性但无明显狭窄的患者。约581例患者DSE异常，其中仅20例（3.4%）符合纳入标准。男性15例，女性5例，平均年龄64.35岁（范围52 - 85岁）；8例患者有CAD病史，且均至少有两种已确定的心血管危险因素。罪犯血管为左前降支10例（50%），右冠状动脉8例（40%），左旋支2例（10%）。罪犯动脉与多巴酚丁胺诱发的室壁运动异常区域之间存在系统性对应关系。检查期间或激发试验期间均未发生并发症。所有患者出院时均服用钙通道阻滞剂，平均随访13个月后情况良好。
DSE可诱发冠状动脉痉挛，但这种情况较为罕见；不过，它可能具有临床相关性，因为它可能部分解释了一些被错误标记为“假阳性”的检查结果。在这种情况下，麦角新碱激发试验是一种安全且可取的方法。
