Research Program in Molecular Medicine, University of Helsinki, Helsinki, Finland.
J Cardiovasc Electrophysiol. 2012 Feb;23(2):194-9. doi: 10.1111/j.1540-8167.2011.02188.x. Epub 2011 Sep 28.
A test involving intravenous infusion of epinephrine has been proposed as a method alternative to exercise stress test in diagnosis of catecholaminergic polymorphic ventricular tachycardia (CPVT). We aimed at estimating the predictive value of intravenous epinephrine administration in CPVT patients with frequent exercise-induced ventricular ectopy.
We recruited 81 subjects, including 25 CPVT-linked ryanodine receptor 2 (RYR2) mutation carriers, 11 genetically undefined CPVT patients, and 45 unaffected family members. All subjects underwent a maximal exercise stress test and an intravenous epinephrine infusion test. Exercise stress test was positive in 25 (31%) patients including 14 of 25 (56%) established RYR2-mutation carriers and all 11 (100%) genetically undefined CPVT patients. Epinephrine infusion induced arrhythmias in 3 (12%) RYR2-mutation carriers, 4 (36%) genetically undefined CPVT patients, and 1 (2%) unaffected family member. A total of 18 exercise stress test positive patients did not respond to intravenous epinephrine administration, whereas only 1 epinephrine test responder had a normal exercise stress test. Thus, if exercise stress test is used as a standard, the sensitivity of the epinephrine infusion test is 28% and specificity is 98%.
Intravenous epinephrine infusion has low sensitivity and may not be considered as an alternative method for a maximal exercise stress test in diagnosis of CPVT.
已经提出了一种涉及静脉内肾上腺素输注的测试，作为诊断儿茶酚胺多形性室性心动过速（CPVT）的运动应激测试的替代方法。我们旨在评估静脉内肾上腺素给药在频发运动诱发室性心律失常的 CPVT 患者中的预测价值。
我们招募了 81 名受试者，包括 25 名 CPVT 相关的兰尼碱受体 2（RYR2）突变携带者、11 名基因未定义的 CPVT 患者和 45 名未受影响的家族成员。所有受试者均接受了最大运动应激测试和静脉内肾上腺素输注测试。运动应激测试阳性的患者有 25 名（31%），其中 14 名（56%）为已确立的 RYR2 突变携带者，11 名（100%）为基因未定义的 CPVT 患者。肾上腺素输注在 3 名（12%）RYR2 突变携带者、4 名（36%）基因未定义的 CPVT 患者和 1 名（2%）未受影响的家族成员中引起心律失常。共有 18 名运动应激测试阳性患者对静脉内肾上腺素给药没有反应，而只有 1 名肾上腺素测试应答者的运动应激测试正常。因此，如果将运动应激测试用作标准，肾上腺素输注测试的敏感性为 28%，特异性为 98%。
静脉内肾上腺素输注的敏感性较低，可能不能被视为 CPVT 诊断中最大运动应激测试的替代方法。
