阿巴美明超声心动图检查：一种诱导心肌缺血和检测冠状动脉疾病的新型药物应激剂的疗效和安全性。国际阿巴美明研究小组。

Arbutamine echocardiography: efficacy and safety of a new pharmacologic stress agent to induce myocardial ischemia and detect coronary artery disease. The International Arbutamine Study Group.

作者信息

Cohen J L, Chan K L, Jaarsma W, Bach D S, Muller D W, Starling M R, Armstrong W F

机构信息

Veterans Affairs Medical Center, East Orange, New Jersey 07019, USA.

出版信息

J Am Coll Cardiol. 1995 Nov 1;26(5):1168-75. doi: 10.1016/0735-1097(95)00296-0.

DOI:10.1016/0735-1097(95)00296-0

PMID:7594028

Abstract

OBJECTIVES

This study sought to determine the efficacy and safety of arbutamine echocardiography in inducing myocardial ischemia and detecting coronary artery disease.

BACKGROUND

Exercise and pharmacologic stress echocardiography are clinically accepted techniques for detecting coronary artery disease. Arbutamine is a new synthetic beta-adrenoceptor agonist developed specifically as a stress agent. Arbutamine is delivered by a new computerized drug delivery device that adjusts the rate of drug infusion according to the patient's heart rate response during stress testing.

METHODS

The sensitivity of arbutamine echocardiography was determined in 143 patients who had coronary artery disease documented by coronary angiography. A subset of these patients (n = 114) also underwent exercise echocardiography. The specificity, or normalcy, of arbutamine echocardiography was determined in 54 patients considered to have a low likelihood of coronary artery disease.

RESULTS

Among those patients who had both stress test results, the incidence of inducing myocardial ischemia (new or worsening wall motion abnormalities) was 79% (95% confidence interval [CI] 69% to 86%, n = 98) for arbutamine and 77% (95% CI 67% to 85%, n = 98) for exercise echocardiography. The sensitivity of detecting coronary artery disease (ischemia or rest wall motion abnormality) was 87% (95% CI 79% to 93%, n = 101) for arbutamine and 83% (95% CI 74% to 90%, n = 101) for exercise echocardiography. The specificity (normalcy) of arbutamine echocardiogrpahy was 96% (95% CI 87% to 100%, n = 52). Arbutamine was well tolerated, and there were no serious adverse events.

CONCLUSIONS

Arbutamine echocardiography is an effective and safe pharmacologic stress test technique for diagnosing or excluding the presence of coronary artery disease. The ability of arbutamine stress to induce myocardial ischemia, detectable by echocardiography, was comparable to that for exercise.

摘要

目的

本研究旨在确定阿巴胺超声心动图在诱发心肌缺血和检测冠状动脉疾病方面的有效性和安全性。

背景

运动和药物负荷超声心动图是临床上公认的检测冠状动脉疾病的技术。阿巴胺是一种专门开发用作负荷剂的新型合成β-肾上腺素能受体激动剂。阿巴胺通过一种新型计算机化药物输送装置给药，该装置在负荷试验期间根据患者的心率反应调整药物输注速率。

方法

对143例经冠状动脉造影证实患有冠状动脉疾病的患者测定阿巴胺超声心动图的敏感性。这些患者中的一部分（n = 114）也接受了运动超声心动图检查。对54例被认为冠状动脉疾病可能性较低的患者测定阿巴胺超声心动图的特异性或正常性。

结果

在两项负荷试验结果均有的患者中，阿巴胺诱发心肌缺血（新出现或加重的室壁运动异常）的发生率为79%（95%置信区间[CI]69%至86%，n = 98），运动超声心动图为77%（95%CI 67%至85%，n = 98）。阿巴胺检测冠状动脉疾病（缺血或静息室壁运动异常）的敏感性为87%（95%CI 79%至93%，n = 101），运动超声心动图为83%（95%CI 74%至90%，n = 101）。阿巴胺超声心动图的特异性（正常性）为96%（95%CI 87%至100%，n = 52）。阿巴胺耐受性良好，未发生严重不良事件。