静息经胸超声心动图节段性室壁运动异常对冠心病的诊断价值。

Diagnostic Value of Regional Wall Motion Abnormalities on Resting Transthoracic Echocardiography for Coronary Artery Disease.

机构信息

Texas A&M School of Medicine, Bryan, Temple, Texas, USA.

Department of Cardiology, Baylor Scott & White, Temple, Texas, USA.

出版信息

Echocardiography. 2024 Nov;41(11):e70031. doi: 10.1111/echo.70031.

DOI:10.1111/echo.70031

PMID:39543988

Abstract

PURPOSE

Regional wall motion abnormality (RWMA) on transthoracic echocardiography (TTE) is used as a clinical decision-making tool to assess systolic function, but there is limited data regarding the validity of this tool to predict obstructive coronary artery disease (CAD). This study evaluates the utility of RWMA on TTE for detecting obstructive CAD in patients with no prior CAD history.

METHODS

We retrospectively reviewed charts of adults who underwent resting TTE and coronary angiography within 30 days, analyzing RWMA in relation to angiographic luminal stenosis.

RESULTS

Among 754 patients (mean age 62, 60% male), TTE sensitivity varied with timing relative to angiography: 68.7% after angiography versus 49.5% before. In ST-elevation myocardial infarction (STEMI) patients (n = 126 after vs. n = 4 before), sensitivity was 89.8%. RWMA correlated with CAD severity, particularly in STEMI cases.

CONCLUSIONS

TTE specificity remains high, but sensitivity varies significantly by timing, with the highest sensitivity in STEMI patients. These findings could refine decision-making in uncertain STEMI cases, supporting TTE as a valuable adjunctive diagnostic tool.

摘要

目的

经胸超声心动图（TTE）上的区域性壁运动异常（RWMA）被用作评估收缩功能的临床决策工具，但关于该工具预测阻塞性冠状动脉疾病（CAD）的有效性的数据有限。本研究评估了 RWMA 在 TTE 上用于检测无 CAD 病史患者中阻塞性 CAD 的效用。

方法

我们回顾性分析了在 30 天内接受静息 TTE 和冠状动脉造影的成年人的图表，分析了 RWMA 与血管造影管腔狭窄的关系。

结果

在 754 名患者（平均年龄 62 岁，60%为男性）中，TTE 的敏感性随与血管造影的时间变化而变化：血管造影后为 68.7%，而血管造影前为 49.5%。在 ST 段抬高型心肌梗死（STEMI）患者中（n=126 例，血管造影后 vs. n=4 例，血管造影前），敏感性为 89.8%。RWMA 与 CAD 严重程度相关，尤其是在 STEMI 病例中。