Aboukhoudir F, Rekik S, Andrieu S, Cheggour S, Metge M, Hirsch J-L, Barnay P, Faugier J-P, Gonzalez S, Aboukhoudir I, Gonthier C, Klioua Y, Pansieri M
Centre hospitalier d'Avignon, 305, rue Raoul-Follereau, 84000 Avignon, France.
Ann Cardiol Angeiol (Paris). 2012 Nov;61(5):311-6. doi: 10.1016/j.ancard.2012.08.023. Epub 2012 Aug 27.
To assess the prevalence of coronary artery spasm during dobutamine stress chocardiography (DSE), to describe clinical and echocardiographic characteristics and prognosis.
We evaluated all the patients with known or suspected coronary artery disease (CAD) referred to our echocardiography laboratory for dobutamine stress test between January 2004 and June 2012, (10013 exams). Those with abnormal DSE underwent coronary angiograms with a systematic methylergometrine intracoronary injection in 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 included.
One thousand and four patients had abnormal DSE, 78 (7.7%) fulfilled the inclusion criteria. There were 57 males and 21 females, mean age was 57.9 years, 37 patients had a known history of CAD. Twenty-four patients had a spasm on the left anterior artery (31%), 37 on the right coronary artery (47%) and 17 on the circumflex (22%). There was a good correlation between spastic arteries and dobutamine induced wall motion abnormalities territories. No complications occurred during the exams or during the provocation test. After 46 months mean follow up; one case of myocardial infarction with normal coronary arteries was noted and six patients experienced recurrent angina responding to treatment intensification.
Coronary artery spasm during DSE but is a rare and under-diagnosed finding; it has, though, to be recognized as it may partly explain some erroneously labelled "false positive" exams. Methylergometrine provocation test should be performed in such a situation to establish the diagnosis. Prognosis appears favourable.
评估多巴酚丁胺负荷超声心动图（DSE）期间冠状动脉痉挛的发生率，描述其临床、超声心动图特征及预后。
我们评估了2004年1月至2012年6月期间因多巴酚丁胺负荷试验转诊至我院超声心动图实验室的所有已知或疑似冠心病（CAD）患者（共10013例检查）。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冠状动脉造影，并进行系统性麦角新碱冠状动脉内注射。纳入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。
1004例患者DSE异常，78例（7.7%）符合纳入标准。其中男性57例，女性21例，平均年龄57.9岁，37例有CAD病史。24例患者左前降支发生痉挛（31%），37例右冠状动脉发生痉挛（47%），17例回旋支发生痉挛（22%）。痉挛动脉与多巴酚丁胺诱发的室壁运动异常区域之间存在良好相关性。检查期间或激发试验期间未发生并发症。平均随访46个月后，发现1例冠状动脉正常的心肌梗死病例，6例患者出现复发性心绞痛，经强化治疗后缓解。
DSE期间冠状动脉痉挛虽为罕见且诊断不足的发现，但应予以识别，因为它可能部分解释一些被错误标记为“假阳性”的检查。在这种情况下应进行麦角新碱激发试验以明确诊断。预后似乎良好。
