Piérard L A, Berthe C, Albert A, Carlier J, Kulbertus H E
Department of Cardiology, University of Liège, Belgium.
Eur Heart J. 1989 Sep;10(9):783-90. doi: 10.1093/oxfordjournals.eurheartj.a059571.
To identify the haemodynamic response to ischaemia induced by dobutamine stress testing, 15 patients with a first acute myocardial infarction underwent right-sided heart catheterization during dobutamine stress cross-sectional echocardiography. Haemodynamic variables and echocardiography were recorded at rest and during dobutamine infusion at each dose from 5 to a maximum of 40 micrograms kg-1 min-1. Ischaemia was diagnosed by cross-sectional echocardiography if asynergy appeared in at least two ventricular segments other than the area of acute myocardial infarction. Ischaemia was absent in six patients (group I) and identified in nine (group II). Response curves for each haemodynamic variable in the two groups were compared by applying Zerbe's method. The response curves were similar in the two groups for heart rate, arterial, right atrial, pulmonary arterial and pulmonary artery wedge pressures. The response curves were significantly different in groups I and II for thermodilution cardiac output, stroke volume and systemic vascular resistance (P less than 0.05). An increase in stroke volume was observed at low dosage of dobutamine in both groups. From low to maximum dose, stroke volume remained unchanged in group I and was significantly decreased in group II. Ischaemia induced by dobutamine stress testing leads to a decrease in stroke volume with no change in pulmonary artery wedge pressure.
为了确定多巴酚丁胺负荷试验诱发缺血时的血流动力学反应，15例首次发生急性心肌梗死的患者在多巴酚丁胺负荷超声心动图检查期间接受了右侧心导管检查。在静息状态以及多巴酚丁胺以5至最大40微克/千克·分钟-1的各剂量输注期间记录血流动力学变量和超声心动图。如果在急性心肌梗死区域以外的至少两个心室节段出现运动不协调，则通过超声心动图诊断为缺血。6例患者（I组）未出现缺血，9例（II组）出现缺血。应用泽尔贝方法比较两组中每个血流动力学变量的反应曲线。两组的心率、动脉压、右心房压、肺动脉压和肺动脉楔压的反应曲线相似。I组和II组的热稀释心输出量、每搏量和全身血管阻力的反应曲线有显著差异（P<0.05）。两组在多巴酚丁胺低剂量时均观察到每搏量增加。从低剂量到最大剂量，I组每搏量保持不变，II组则显著下降。多巴酚丁胺负荷试验诱发的缺血导致每搏量减少，而肺动脉楔压无变化。
