Sochowski R A, Yvorchuk K J, Yang Y, Rattes M F, Chan K L
University of Ottawa Heart Institute, Ontario, Canada.
J Am Soc Echocardiogr. 1995 Jul-Aug;8(4):482-7. doi: 10.1016/s0894-7317(05)80335-9.
The aim of this study was to determine the relative sensitivity, specificity, accuracy, and tolerance of dobutamine and dipyridamole stress echocardiography in patients with a lower likelihood of severe coronary artery disease. Previous comparative studies, which included patients with a history of myocardial infarction or a high incidence of coronary artery disease, showed both methods to have similar and acceptable diagnostic accuracy. To assess the role of these agents in evaluating patients with a lower likelihood of significant coronary artery disease, a lower-risk group was selected by excluding patients with known coronary artery disease, myocardial infarction, unstable angina, or strongly positive stress test results. Dobutamine and dipyridamole stress echocardiographic studies were performed in random order, before coronary angiography. Of the 46 patients enrolled (31 men and 15 women), 24 had atypical chest pain or none at all. Coronary angiography revealed no significant disease in 22 (48%), single-vessel disease in 11 (24%), and multivessel disease in only 13 patients (28%). Dobutamine and dipyridamole stress echocardiography were equally well tolerated, with identical accuracy (76%) that was maintained in patients with atypical symptoms. This confirms the usefulness of both dobutamine and dipyridamole stress echocardiography in evaluating patients with suspected coronary artery disease and extends this role to a lower-risk group for severe disease who often have atypical symptoms. The choice of which agent is used should reflect an institution's experience.
本研究的目的是确定多巴酚丁胺和双嘧达莫负荷超声心动图在严重冠状动脉疾病可能性较低的患者中的相对敏感性、特异性、准确性和耐受性。以往的比较研究纳入了有心肌梗死病史或冠状动脉疾病高发病率的患者，结果显示两种方法具有相似且可接受的诊断准确性。为了评估这些药物在评估冠状动脉疾病可能性较低的患者中的作用，通过排除已知患有冠状动脉疾病、心肌梗死、不稳定型心绞痛或负荷试验结果强阳性的患者，选择了一个低风险组。在冠状动脉造影之前，以随机顺序进行多巴酚丁胺和双嘧达莫负荷超声心动图检查。在纳入的46例患者（31例男性和15例女性）中，24例有非典型胸痛或根本没有胸痛。冠状动脉造影显示，22例（48%）无明显疾病，11例（24%）为单支血管病变，仅13例（28%）为多支血管病变。多巴酚丁胺和双嘧达莫负荷超声心动图的耐受性相同，准确性相同（76%），在有非典型症状的患者中也保持如此。这证实了多巴酚丁胺和双嘧达莫负荷超声心动图在评估疑似冠状动脉疾病患者中的有用性，并将这一作用扩展到经常有非典型症状的严重疾病低风险组。使用哪种药物的选择应反映机构的经验。
