Department of Echocardiography, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China.
Chin Med J (Engl). 2011 Jul;124(14):2089-95.
Stress echocardiography is mainly used in detection of coronary artery disease (CAD) and to assess risk. This study aimed to use adenosine stress echocardiography (ASE) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) to noninvasively assess coronary stenosis in patients with chest pain syndromes or anginal equivalent.
NT-proBNP was measured after overnight fast in fifty patients, 42 males and 8 females, who were (57 ± 11) years old. They then underwent echocardiography before and during adenosine administration. Left ventricular (LV) diastolic function analyzed included mitral annular early (E') and late velocity (A') both at the mitral septal and lateral level and the mitral inflow to annulus ratio (E/E'). Coronary angiography was performed the following day after which patients were assigned to three groups: normal results (16 patients), stenosis 50% - 69% (17 patients) and stenosis ≥ 70% (17 patients).
NT-proBNP levels in the groups of stenosis 50% - 69% and ≥ 70% were significantly higher than that in the group with normal results (P = 0.014 and P = 0.040). During adenosine stress, the E/E' in the group of stenosis ≥ 70% was higher than in the group of normal results (P = 0.024). E'(lateral)/A'(lateral) in the group of stenosis 50% - 69% and E'(septal)/A'(septal) and E'(lateral)/A'(lateral) in the group of stenosis ≥ 70% were also decreased during stress compared with baseline (P = 0.003, P = 0.001, P = 0.022). The variation of E'(septal)/A'(septal) before and during adenosine stress (ΔE'(septal)/A'(septal)) between the groups of normal results and stenosis ≥ 70% were significantly different (P = 0.001). By receiver operating characteristic (ROC), the specificity of ΔE'(septal)/A'(septal) ≥ 0.037 predicting coronary stenosis < 70% was 94%. The sensitivity and specificity of NT-proBNP ≥ 544.6 fmol/ml in predicting coronary stenosis ≥ 70% were 93% and 75%, respectively. NT-proBNP inversely correlated with E'(lateral)/A'(lateral) (r = - 0.390, P = 0.014) and positively correlated with E/E'(lateral) (r = 0.550, P = 0.001).
Adenosine might induce diastolic dysfunction in patients with coronary stenosis more than 70% and NT-proBNP could reflect LV diastolic function to a certain extent. We support the prediction that most patients having chest pain syndromes or anginal equivalent with NT-proBNP < 544.6 fmol/ml and in ASE ΔE'(septal)/A'(septal) ≥ 0.037 might be spared coronary angiography.
超声心动图负荷试验主要用于检测冠状动脉疾病（CAD）并评估风险。本研究旨在使用腺苷超声心动图（ASE）和 N 末端 B 型利钠肽前体（NT-proBNP）对胸痛综合征或等效心绞痛患者的冠状动脉狭窄进行非侵入性评估。
对 50 名患者（42 名男性和 8 名女性）进行 overnight fast（禁食过夜），并测量 NT-proBNP。然后在给予腺苷前后进行超声心动图检查。分析左心室（LV）舒张功能，包括二尖瓣环的早期（E'）和晚期速度（A'），在二尖瓣间隔和外侧水平，以及二尖瓣流入到环的比值（E/E'）。次日进行冠状动脉造影，根据结果将患者分为三组：正常结果（16 例）、狭窄 50%-69%（17 例）和狭窄≥70%（17 例）。
狭窄 50%-69%和狭窄≥70%组的 NT-proBNP 水平明显高于正常结果组（P=0.014 和 P=0.040）。在腺苷应激期间，狭窄≥70%组的 E/E'高于正常结果组（P=0.024）。在狭窄 50%-69%组中，E'（外侧）/A'（外侧）和在狭窄≥70%组中 E'（间隔）/A'（间隔）和 E'（外侧）/A'（外侧）在应激期间与基线相比均降低（P=0.003、P=0.001、P=0.022）。正常结果组和狭窄≥70%组之间 E'（间隔）/A'（间隔）在腺苷应激前后的变化（ΔE'（间隔）/A'（间隔））有显著差异（P=0.001）。通过接收者操作特征（ROC），ΔE'（间隔）/A'（间隔）≥0.037 预测狭窄<70%的特异性为 94%。NT-proBNP≥544.6 fmol/ml 预测狭窄≥70%的敏感性和特异性分别为 93%和 75%。NT-proBNP 与 E'（外侧）/A'（外侧）呈负相关（r=-0.390，P=0.014），与 E/E'（外侧）呈正相关（r=0.550，P=0.001）。
腺苷可能会引起冠状动脉狭窄超过 70%的患者出现舒张功能障碍，NT-proBNP 在一定程度上可以反映 LV 舒张功能。我们支持这一预测，即大多数患有胸痛综合征或等效心绞痛且 NT-proBNP<544.6 fmol/ml 和 ASE ΔE'（间隔）/A'（间隔）≥0.037 的患者可能无需进行冠状动脉造影。
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