Abreu A, Nunes H, Pereira H, Pitta L, Catarino C, Ferreira M, Gonçalves J M, Salomão S, Antunes A M
Interna Graduada de Cardiologia, Hospital de Santa Marta de Lisboa.
Rev Port Cardiol. 1995 Mar;14(3):203-12, 187.
To evaluate dobutamine echocardiography capacity to diagnose coronary artery disease.
Prospective clinical study.
Cardiology Department of Hospital Santa Marta.
32 patients with suspected coronary artery disease, without myocardial infarction, have been studied.
An intravenous perfusion of dobutamine with gradual doses, from 5 to 40 micrograms/kg/min, and increments of 5 to 10 micrograms/kg/min, in 3 minute stages, except the last stage which lasted only 1 minute with 40 micrograms/kg, was performed. Twelve-lead ECG were registered to detect ST changes and symptoms, namely chest pain. Basal and dobutamine bidimensional echocardiograms, in the end of each stage and during recovery, were registered in video. The segmental analysis was performed considering the left ventricle divided in 16 segments. It was considered positive the occurrence or aggravation of the contractility asynergy of the left ventricle with inotropic stress. All the patients were submitted to coronary arteriography.
Due to the bad quality of the echocardiographic images 2 patients were excluded. The stress dobutamine echocardiograms were positive in 14 P and negative in 16 P. The coronary arteriography showed coronary disease in 18 cases and absence of significant lesions in 12 cases. The values for sensitivity, specificity positive predictive value and negative predictive value obtained with dobutamine echocardiography were, 78% and 100% and 75% respectively. In Dobutamine-ECG, 7P had ST segment changes, 2 of them with chest pain values for sensitivity, specificity, positive and negative predictive value with dobutamine-ECG were, 39%, 100% and 52%, respectively. The occurrence of side-effects was observed in 8 P (27%): ventricular tachycardia (2 P-7%), complex ventricular ectopy (4 P-13%), chest pain (2 P-7%), headache (1 P-3%), nausea (1 P-3%) and palpitations (2 P-7%). There was no significant difference in the occurrence of side-effects in the two groups of patients, with and without coronary artery disease (33% vs 17%, respectively; p = ns). The reasons for early discontinuation of dobutamine infusion were: ventricular tachycardia (2 P), complex ventricular ectopy (2 P) and chest pain (1 P). Heart rate, systolic blood pressure and double-product did not differ significantly in patients with and without coronary artery disease. In dobutamine electrocardiography 7 P had ST segment changes, 2 of them with chest pain.
Dobutamine echocardiography showed in this study elevated values for sensitivity and specificity, however sensitivity can be increased with better technical conditions.
评估多巴酚丁胺超声心动图诊断冠状动脉疾病的能力。
前瞻性临床研究。
圣玛尔塔医院心脏病科。
研究了32例疑似冠状动脉疾病且无心肌梗死的患者。
静脉输注多巴酚丁胺，剂量逐渐增加，从5至40微克/千克/分钟，每次增加5至10微克/千克/分钟，每3分钟为一个阶段，最后一个阶段持续1分钟，剂量为40微克/千克。记录12导联心电图以检测ST段变化和症状，即胸痛。在每个阶段结束时和恢复期间记录基础和多巴酚丁胺二维超声心动图，并保存为视频。采用节段分析法，将左心室分为16个节段。将在正性肌力负荷下左心室收缩力协同异常的出现或加重视为阳性。所有患者均接受冠状动脉造影。
由于超声心动图图像质量差，排除2例患者。多巴酚丁胺负荷超声心动图14例阳性，16例阴性。冠状动脉造影显示18例有冠状动脉疾病，12例无明显病变。多巴酚丁胺超声心动图的敏感性、特异性、阳性预测值和阴性预测值分别为78%、100%、75%。在多巴酚丁胺心电图检查中，7例出现ST段改变，其中2例伴有胸痛，多巴酚丁胺心电图的敏感性、特异性、阳性和阴性预测值分别为39%、100%和52%。观察到8例（27%）出现副作用：室性心动过速（2例-7%）、复杂性室性早搏（4例-13%）、胸痛（2例-7%）、头痛（1例-3%）、恶心（1例-3%）和心悸（2例-7%）。有冠状动脉疾病和无冠状动脉疾病的两组患者副作用发生率无显著差异（分别为33%和17%；p=无显著性差异）。多巴酚丁胺输注提前终止的原因有：室性心动过速（2例）、复杂性室性早搏（2例）和胸痛（1例）。有冠状动脉疾病和无冠状动脉疾病的患者心率、收缩压和双乘积无显著差异。在多巴酚丁胺心电图检查中，7例出现ST段改变，其中2例伴有胸痛。
本研究中多巴酚丁胺超声心动图显示敏感性和特异性值升高，然而在更好的技术条件下敏感性可以提高。
