V.A. Almazov National Medical Research Center of the Ministry of Health of the Russian Federation, Saint Petersburg.
V.A. Almazov National Medical Research Center of the Ministry of Health of the Russian Federation, Saint Petersburg; Saint Petersburg State Pediatric Medical University of the Ministry of Health of Russia, Saint Petersburg.
Kardiologiia. 2021 Mar 6;61(2):62-68. doi: 10.18087/cardio.2021.2.n1320.
Aim To determine diagnostic capabilities of the expanded protocol for stress echocardiography (stress-EchoCG) with comprehensive evaluation of clinical and echocardiographic indexes in differential diagnosis of dyspnea.Material and methods This study included 243 patients (123 women and 120 men) who were referred to outpatient stress-EchoCG during one calendar month. For 80 patients complaining about shortness of breath, the expanded stress-EchoCG protocol with treadmill exercise was performed. During the exercise, E / e' and tricuspid regurgitation velocity were determined, and clinical features and possible nature of dyspnea were evaluated.Results Shortness of breath had an ischemic origin in 17.5 % of 80 patients; 13.8 % had criteria of elevated left ventricular end-diastolic pressure; 17.5 % of patients had clinical signs of bronco-pulmonary pathology; 5.0 % had moderate and severe mitral regurgitation; 20 % displayed signs of chronotropic insufficiency during exercise including on the background of beta-blocker therapy; 15.0 % of patients displayed a hypertensive response to exercise, which was associated with signs of chronotropic insufficiency in 50 % of them; and 1.3 % had signs of hyperventilation syndrome. In addition to diagnosis of transient ischemia, additional information about the nature of shortness of breath was obtained for 72.5 % of patients. Based on results of the test, objective causes for dyspnea were not identified for 10.0 % of patients.Conclusion The expanded stress-EchoCG protocol with exercise allows obtaining information about the nature of dyspnea for most patients with shortness of breath of a non-ischemic origin. For this patient category, expanding the stress-EchoCG protocol does not increase duration of the study and is economically beneficial for diagnosis of chronic heart failure and other causes for shortness of breath.
通过综合评估临床和超声心动图指标，确定扩展的应激超声心动图（应激-EchoCG）协议在呼吸困难鉴别诊断中的诊断能力。
本研究纳入了在一个日历月内接受门诊应激-EchoCG 检查的 243 例患者（123 例女性和 120 例男性）。对于 80 例主诉呼吸困难的患者，进行了扩展的应激-EchoCG 协议和跑步机运动试验。在运动过程中，测定 E/A 和三尖瓣反流速度，并评估临床特征和呼吸困难的可能性质。
80 例患者中，17.5%的呼吸困难源于缺血；13.8%的患者存在左心室舒张末期压力升高的标准；17.5%的患者有支气管-肺部病理的临床体征；5.0%的患者存在中度和重度二尖瓣反流；20%的患者在运动时表现出变时功能不全的迹象，包括在β受体阻滞剂治疗的背景下；15.0%的患者对运动表现出高血压反应，其中 50%的患者伴有变时功能不全的迹象；1.3%的患者有过度通气综合征的迹象。除了诊断短暂性缺血外，还为 72.5%的患者获得了关于呼吸困难性质的额外信息。基于检查结果，10.0%的患者未确定呼吸困难的客观原因。
运动扩展的应激-EchoCG 协议可获得大多数非缺血性呼吸困难患者的呼吸困难性质信息。对于这一患者群体，扩展应激-EchoCG 协议不会增加研究时间，并且在诊断慢性心力衰竭和其他呼吸困难原因方面具有经济效益。
