Beleslin B D, Ostojic M, Stepanovic J, Djordjevic-Dikic A, Stojkovic S, Nedeljkovic M, Stankovic G, Petrasinovic Z, Gojkovic L, Vasiljevic-Pokrajcic Z
Department of Diagnostic and Catheterization Laboratories, University Clinical Center, Belgrade, Serbia.
Circulation. 1994 Sep;90(3):1168-76. doi: 10.1161/01.cir.90.3.1168.
Exercise and pharmacological stress echocardiography have emerged as convenient alternatives to myocardial scintigraphy. The objective of this study was to compare in the same patients the diagnostic values of exercise, dobutamine, and dipyridamole stress echocardiography tests for detection of myocardial ischemia.
We performed exercise (maximal treadmill Bruce protocol), dobutamine (up to 40 micrograms/kg per minute) and dipyridamole (up to 0.84 mg/kg over 10 minutes) stress echocardiography tests, in random sequence and on separate days, in 136 consecutive patients. All patients underwent coronary angiography. Significant coronary artery disease was defined by quantitative coronary angiography as a lesion with a diameter stenosis > or = 50%. A stress echocardiogram was considered positive when new or worsening of preexisting wall motion abnormality was observed. Most of the patients (94%) were receiving the same antianginal medication for each stress test; 59 patients were receiving concomitant beta-blocker therapy. The prevalence of coronary artery disease was 87.5%, with 108 patients having one-vessel coronary artery disease. Peak heart rate and systolic blood pressure were higher with exercise than with dobutamine or dipyridamole (P < .01). Sensitivity of exercise, dobutamine, and dipyridamole stress echocardiography was 88%, 82%, and 74% (dipyridamole versus exercise, P < .01), respectively. Specificity was 82%, 77%, and 94%, respectively. The overall accuracy was 87%, 82%, and 77% (dipyridamole versus exercise, P < .01), respectively. The accuracy of dipyridamole was higher (P = .02) in the group of patients not receiving beta-blockers (84%) than in the patients receiving beta-blocker therapy (66%), whereas the accuracy of exercise and dobutamine were only slightly higher in the patients not receiving beta-blockers. Significant side effects occurred in 3%, 11%, and 1% of patients during exercise, dobutamine, and dipyridamole tests, respectively.
Despite the different hemodynamic effects, exercise, dobutamine, and dipyridamole echocardiography have high overall diagnostic values. In this group of patients with a predominance of one-vessel coronary artery disease, the overall diagnostic accuracy of stress echocardiography tests was higher for exercise than for dobutamine or dipyridamole. Concomitant beta-blocker therapy significantly decreased the accuracy of the dipyridamole stress echocardiography test. Pharmacological stress testing (dipyridamole without beta-blockers) can therefore be used as an efficient option for detection of myocardial ischemia in patients who are unable or poorly motivated to exercise adequately.
运动和药物负荷超声心动图已成为心肌闪烁显像的便捷替代方法。本研究的目的是在同一组患者中比较运动、多巴酚丁胺和双嘧达莫负荷超声心动图检测心肌缺血的诊断价值。
我们对136例连续患者依次随机且在不同日期进行了运动（最大运动平板Bruce方案）、多巴酚丁胺（最大剂量40微克/千克每分钟）和双嘧达莫（10分钟内最大剂量0.84毫克/千克）负荷超声心动图检查。所有患者均接受了冠状动脉造影。定量冠状动脉造影将直径狭窄≥50%的病变定义为显著冠状动脉疾病。当观察到新的或原有室壁运动异常加重时，负荷超声心动图被认为是阳性。大多数患者（94%）在每次负荷试验时服用相同的抗心绞痛药物；59例患者接受了β受体阻滞剂联合治疗。冠状动脉疾病的患病率为87.5%，108例患者为单支冠状动脉疾病。运动时的峰值心率和收缩压高于多巴酚丁胺或双嘧达莫时（P<.01）。运动、多巴酚丁胺和双嘧达莫负荷超声心动图的敏感性分别为88%、82%和74%（双嘧达莫与运动相比，P<.01）。特异性分别为82%、77%和94%。总体准确性分别为87%、82%和77%（双嘧达莫与运动相比，P<.01）。在未接受β受体阻滞剂治疗的患者组中，双嘧达莫的准确性较高（P =.02）（84%）高于接受β受体阻滞剂治疗的患者（66%），而运动和多巴酚丁胺在未接受β受体阻滞剂治疗的患者中的准确性仅略高。运动、多巴酚丁胺和双嘧达莫试验期间分别有3%、11%和1%的患者出现显著副作用。
尽管有不同的血流动力学效应，但运动负荷、多巴酚丁胺和双嘧达莫负荷超声心动图具有较高的总体诊断价值。在这组以单支冠状动脉疾病为主的患者中，运动负荷超声心动图检查的总体诊断准确性高于多巴酚丁胺或双嘧达莫。β受体阻滞剂联合治疗显著降低了双嘧达莫负荷超声心动图检查的准确性。因此，药物负荷试验（不使用β受体阻滞剂的双嘧达莫）可作为不能充分运动或运动积极性差的患者检测心肌缺血的有效选择。
