Herregods M C, Anastassiou I, Van Cleemput J, Bijnens B, De Geest H, Daenen W, Vanhaecke J
Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
J Heart Lung Transplant. 1994 Nov-Dec;13(6):1039-44.
Dobutamine stress echocardiography was performed in 28 heart transplant recipients to study its value in the detection and staging of transplant vasculopathy. Fourteen patients had angiographic evidence of coronary artery disease (group 1), and 14 had angiographically normal coronary arteries (group 2). The dobutamine stress protocol called for a dose increase of dobutamine every 3 minutes until the age-predicted maximal heart rate was achieved. In groups 1 and 2, the mean maximal dose of dobutamine was, respectively, 24 +/- 9 micrograms/kg min and 29 +/- 8 micrograms/kg min, and the mean rate-pressure product was, respectively, 12386 +/- 1777 mm Hg/min and 10753 +/- 1085 mm Hg/min at rest, increasing to 20987 +/- 4020 mm Hg/min and 19795 +/- 2728 mm Hg/min at maximal dose. No patient in group 1 or 2 had deterioration of global or regional wall motion under dobutamine stress. In group 1, seven patients had wall motion abnormalities at rest, normalizing in five of them under dobutamine stress. In group 2, four patients had wall motion abnormalities at rest, normalizing in all patients under dobutamine stress. Consequently, this protocol of dobutamine stress echocardiography is unsuitable for the early detection of transplant vasculopathy despite its proven value in the general population. Conversely, these data suggest that the functional sequelae of transplant vasculopathy are not necessarily prominent, despite the known angiographic underestimation of the extent of the disease.
对28例心脏移植受者进行了多巴酚丁胺负荷超声心动图检查，以研究其在检测移植血管病变及分期中的价值。14例患者有冠状动脉疾病的血管造影证据（第1组），14例冠状动脉造影正常（第2组）。多巴酚丁胺负荷方案要求每3分钟增加一次多巴酚丁胺剂量，直至达到年龄预测的最大心率。在第1组和第2组中，多巴酚丁胺的平均最大剂量分别为24±9微克/千克·分钟和29±8微克/千克·分钟，静息时平均速率压力乘积分别为12386±1777毫米汞柱/分钟和10753±1085毫米汞柱/分钟，最大剂量时分别增至20987±4020毫米汞柱/分钟和19795±2728毫米汞柱/分钟。第1组和第2组均无患者在多巴酚丁胺负荷下出现整体或局部室壁运动恶化。在第1组中，7例患者静息时存在室壁运动异常，其中5例在多巴酚丁胺负荷下恢复正常。在第2组中，4例患者静息时存在室壁运动异常，所有患者在多巴酚丁胺负荷下均恢复正常。因此，尽管多巴酚丁胺负荷超声心动图在普通人群中已被证明有价值，但该方案不适用于移植血管病变的早期检测。相反，这些数据表明，尽管已知血管造影对疾病范围的低估，但移植血管病变的功能后遗症不一定突出。
