Takeuchi M, Araki M, Nakashima Y, Kuroiwa A
Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
J Am Soc Echocardiogr. 1994 May-Jun;7(3 Pt 1):242-52. doi: 10.1016/s0894-7317(14)80394-5.
The aim of this study was to validate the usefulness of dobutamine stress echocardiography to detect residual ischemia and significant stenosis at the infarct zone in patients with acute myocardial infarction. Dobutamine stress echocardiography and stress thallium-201 single-photon emission computed tomography were performed on 40 consecutive patients 1 month after the onset of acute myocardial infarction. Dobutamine was infused incrementally, and wall motion score index at the infarct zone was calculated before and at peak dobutamine infusion. The patients were divided into three groups according to the change in wall motion at the infarct zone (improved, unchanged, or worsened wall motion, respectively). Tomographic thallium images of the infarct zone were assessed visually. All patients underwent quantitative coronary angiography, and significant stenosis was defined as 50% or greater stenosis. In patients who showed a persistent defect and significant stenosis of the infarct-related artery, resting thallium-201 single-photon emission computed tomography was performed when possible. There was a significantly higher incidence of residual ischemia at the infarct zone in patients with worsened wall motion (85%) and unchanged wall motion (63%) than in those with improved wall motion (8%). The residual stenosis of the infarct-related artery was more severe in patients with worsened or unchanged wall motion than in those with improved wall motion (worsened 82.6% +/- 17.7%, unchanged 93.7% +/- 12.6%, and improved 37.1% +/- 24.4%). The use of worsened or unchanged wall motion at the infarct zone for detecting significant residual stenosis of the infarct-related artery resulted in a sensitivity of 93% and a specificity of 91%, respectively. Worsened wall motion at the infarct zone by dobutamine stress echocardiography strongly suggests residual ischemia. Conversely, less ischemia and less significant stenosis are associated with improved wall motion. Unchanged wall motion suggests severe residual stenosis and sometimes indicates ischemia. It may reflect a hibernating myocardium, but the prognostic significance of this finding should be determined by revascularization.
本研究的目的是验证多巴酚丁胺负荷超声心动图在检测急性心肌梗死患者梗死区域残余缺血和严重狭窄方面的实用性。对40例急性心肌梗死发病1个月后的连续患者进行了多巴酚丁胺负荷超声心动图和负荷铊-201单光子发射计算机断层扫描。多巴酚丁胺逐步输注，并在多巴酚丁胺输注前和输注峰值时计算梗死区域的壁运动评分指数。根据梗死区域壁运动的变化将患者分为三组（分别为壁运动改善、不变或恶化）。对梗死区域的断层铊图像进行视觉评估。所有患者均接受了定量冠状动脉造影，严重狭窄定义为狭窄50%或更高。在梗死相关动脉存在持续缺损和严重狭窄的患者中，尽可能进行静息铊-201单光子发射计算机断层扫描。梗死区域壁运动恶化的患者（85%）和壁运动不变的患者（63%）残余缺血的发生率显著高于壁运动改善的患者（8%）。梗死相关动脉的残余狭窄在壁运动恶化或不变的患者中比壁运动改善的患者更严重（恶化82.6%±17.7%，不变93.7%±12.6%，改善37.1%±24.4%）。使用梗死区域壁运动恶化或不变来检测梗死相关动脉的严重残余狭窄，敏感性分别为93%，特异性为91%。多巴酚丁胺负荷超声心动图显示梗死区域壁运动恶化强烈提示残余缺血。相反，缺血较少和狭窄不严重与壁运动改善相关。壁运动不变提示严重残余狭窄，有时提示缺血。它可能反映了冬眠心肌，但这一发现的预后意义应由血运重建来确定。
