Mairesse G H, Marwick T H, Vanoverschelde J L, Baudhuin T, Wijns W, Melin J A, Detry J M
Division of Cardiology, University of Louvain Medical School, Brussels, Belgium.
J Am Coll Cardiol. 1994 Oct;24(4):920-7. doi: 10.1016/0735-1097(94)90850-8.
This study was designed to establish the appropriate diagnostic criteria for positive dobutamine electrocardiographic (ECG) stress test results and to compare their accuracy with those of dobutamine two-dimensional echocardiography and perfusion scintigraphy.
Conventional criteria for positive findings on ECG exercise testing may not be appropriate for use with dobutamine ECG stress testing.
One hundred twenty-nine consecutive patients with an interpretable ECG and without previous myocardial infarction were prospectively studied at the time of coronary arteriography. All completed a standard dobutamine protocol (5 to 40 micrograms/kg body weight per min in 3-min dose increments) without side effects. Significant coronary artery disease, defined as > 50% lumen diameter stenosis of a major epicardial coronary artery on coronary angiography, was present in 83 patients. Empiric receiver operating curves were generated for various ECG criteria derived from computer-averaged signals.
The best ECG criterion, with a sensitivity of 42% and a specificity of 83%, was an ST segment shift, relative to baseline, of 0.5 mm 80 ms after the J point. The sensitivity of this criterion was greater than that of the conventional criterion of 1-mm ST segment depression 60 (23%) or 80 (18%) ms after the J point, was comparable to that of chest pain occurring during the test (44%, p = NS) but remained inferior to the sensitivities of technetium-99m methoxyl isobutyl isonitrile (mibi) perfusion (76%) or stress echocardiography (76%, p < 0.001, for both). The specificity of this criterion was not significantly different from that of technetium-99m mibi perfusion tomography (65%) or stress echocardiography (89%) but was superior to that of chest pain (59%, p < 0.025).
We conclude that this new criterion for dobutamine electrocardiography is specific but that an imaging technique is still required to accurately predict coronary artery disease.
本研究旨在确立多巴酚丁胺心电图（ECG）负荷试验阳性结果的合适诊断标准，并将其准确性与多巴酚丁胺二维超声心动图和灌注闪烁显像的准确性进行比较。
心电图运动试验阳性结果的传统标准可能不适用于多巴酚丁胺心电图负荷试验。
在冠状动脉造影时，对129例连续的、心电图可解读且既往无心肌梗死的患者进行前瞻性研究。所有患者均完成标准多巴酚丁胺方案（5至40微克/千克体重每分钟，以3分钟剂量递增）且无副作用。83例患者存在显著冠状动脉疾病，定义为冠状动脉造影显示主要心外膜冠状动脉管腔直径狭窄>50%。针对从计算机平均信号得出的各种心电图标准生成经验性受试者工作曲线。
最佳心电图标准为J点后80毫秒ST段相对于基线偏移0.5毫米，其敏感性为42%，特异性为83%。该标准的敏感性高于J点后60（23%）或80（18%）毫秒ST段压低1毫米的传统标准，与试验期间出现胸痛的敏感性相当（44%，p=无显著差异），但仍低于锝-99m甲氧基异丁基异腈（mibi）灌注（76%）或负荷超声心动图（76%，两者p<0.001）的敏感性。该标准的特异性与锝-99m mibi灌注断层显像（65%）或负荷超声心动图（89%）的特异性无显著差异，但优于胸痛的特异性（59%，p<0.025）。
我们得出结论，多巴酚丁胺心电图的这一新标准具有特异性，但仍需要成像技术来准确预测冠状动脉疾病。
