经食管多巴酚丁胺超声心动图评估冠状动脉血流储备

Coronary flow reserve assessment by dobutamine transesophageal Doppler echocardiography.

作者信息

Stoddard M F, Prince C R, Morris G T

机构信息

Department of Medicine, University of Louisville, Kentucky 40202.

出版信息

J Am Coll Cardiol. 1995 Feb;25(2):325-32. doi: 10.1016/0735-1097(94)00395-7.

DOI:10.1016/0735-1097(94)00395-7

PMID:7829784

Abstract

OBJECTIVES

This study attempted to determine the sensitivity and specificity of coronary flow reserve derived using transesophageal echocardiography for left anterior descending coronary artery stenosis.

BACKGROUND

Transesophageal echocardiography can be used to measure coronary flow velocity and may provide a less invasive means of assessing coronary flow reserve.

METHODS

Seventy-eight adult patients were studied by pulsed Doppler transesophageal echocardiography of the proximal left anterior descending coronary artery during a control period and peak (i.e., 40 micrograms/kg body weight per min) dobutamine infusion. Coronary flow reserve index was calculated as the ratio of maximal diastolic coronary velocity at peak dobutamine infusion to the control level and was considered abnormal if < 1.81. Two-dimensional transesophageal left ventricular views were obtained for analysis of wall motion.

RESULTS

Coronary angiography showed > or = 70% (group A, n = 18), 0% to < 70% (group B, n = 21) and no (group C, n = 39) left anterior descending coronary artery diameter stenosis. An abnormal coronary flow reserve index did not differ from a new regional wall motion abnormality in sensitivity for left anterior descending coronary stenosis in group A (15 [83%] of 18 vs. 15 [83%] of 18, p = NS) but was significantly more sensitive in group B (12 [57%] of 21 vs. 2 [10%] of 21, p < 0.025). The specificity for no left anterior descending coronary stenosis in group C between a normal coronary flow reserve index and no new regional wall motion abnormality did not differ (87% vs. 97%, p = NS).

CONCLUSION

Doppler coronary flow reserve and two-dimensional dobutamine transesophageal echocardiography are equally sensitive for the detection of left anterior descending coronary stenosis > or = 70% and equally specific. However, Doppler coronary flow reserve, compared with two-dimensional dobutamine transesophageal echocardiography, is more sensitive for intermediate left anterior descending coronary stenosis and may play a significant adjunctive role to cardiac catheterization and other noninvasive techniques for assessing coronary artery disease.

摘要

目的

本研究试图确定经食管超声心动图测量的左前降支冠状动脉狭窄的冠脉血流储备的敏感性和特异性。

背景

经食管超声心动图可用于测量冠状动脉血流速度，可能提供一种侵入性较小的评估冠脉血流储备的方法。

方法

78例成年患者在对照期和静脉注射多巴酚丁胺达到峰值（即40微克/千克体重/分钟）时，行经食管超声心动图对左前降支冠状动脉近端进行脉冲多普勒检查。冠脉血流储备指数计算为多巴酚丁胺注射峰值时最大舒张期冠状动脉速度与对照水平的比值，若<1.81则认为异常。获取经食管二维左心室图像以分析室壁运动。

结果

冠状动脉造影显示左前降支冠状动脉直径狭窄≥70%（A组，n = 18）、0%至<70%（B组，n = 21）和无狭窄（C组，n = 39）。异常冠脉血流储备指数对A组左前降支冠状动脉狭窄的敏感性与新出现的局部室壁运动异常无差异（18例中的15例[83%]对18例中的15例[83%]，p = 无显著性差异），但在B组中敏感性显著更高（21例中的12例[57%]对21例中的2例[10%]，p < 0.025）。C组中正常冠脉血流储备指数与无新出现的局部室壁运动异常对无左前降支冠状动脉狭窄的特异性无差异（87%对97%，p = 无显著性差异）。