Baer F M, Theissen P, Smolarz K, Voth E, Sechtem U, Schicha H, Hilger H H
Klinik III für Innere Medizin, Universität zu Köln.
Z Kardiol. 1993 Aug;82(8):494-503.
Safety and sensitivity of gradient-echo magnetic resonance imaging (MRI) for the identification of significant coronary artery stenoses using pharmacologic stress testing was assessed in 61 patients with > or = 70% stenosis of a major coronary artery and a normal left ventricle. After MRI at rest 28 patients underwent dobutamine-MRI during steady-state dobutamine infusion (5, 10, 15 and 20 micrograms/kg/min) and 33 patients had dipyridamole-MRI after high-dose dipyridamole infusion (0.75 mg/kg over 10 min). All patients additionally performed standard ECG exercise stress testing (EST). Segmental wall motion analysis was performed in basal and midventricular short axis tomograms by two observers. A segment was graded pathologic if transient dobutamine or dipyridamole induced wall motion abnormalities could be detected. For comparison to coronary angiography findings, each segment was assigned to one of the coronary artery perfusion territories. There were no serious side-effects during dobutamine and dipyridamole infusion leading to termination of the study protocol. Peak double product during dobutamine infusion was significantly higher (p < 0.001) than after dipyridamole infusion (18.493 +/- 4.311 versus 12.799 +/- 2.694 mm Hg/min). Overall sensitivity of dobutamine and dipyridamole-MRI for coronary artery disease (CAD) was 85% and 84%. Regional asynergy by dobutamine and dipyridamole-MRI was observed in 73% versus 79% patients with single- and 100% versus 92% with multi-vessel disease. Individual coronary artery stenoses were correctly identified by segmental wall motion abnormalities in 87% versus 81% for left anterior descending, 62% versus 86% for left circumflex and 78% versus 92% for right coronary artery stenoses. In conclusion, dobutamine and dipyridamole-MRI are well tolerated and safe non-exercise dependent tests for detection and localization of hemodynamically significant coronary artery stenoses with a similar diagnostic accuracy but with a better control of stress intensity and duration provided by dobutamine.
在61例主要冠状动脉狭窄≥70%且左心室正常的患者中，评估了使用药物负荷试验的梯度回波磁共振成像（MRI）识别显著冠状动脉狭窄的安全性和敏感性。静息MRI检查后，28例患者在持续静脉输注多巴酚丁胺（5、10、15和20微克/千克/分钟）期间接受多巴酚丁胺-MRI检查，33例患者在大剂量输注双嘧达莫（10分钟内0.75毫克/千克）后接受双嘧达莫-MRI检查。所有患者还进行了标准的心电图运动负荷试验（EST）。由两名观察者在心底和心室中部短轴断层图像上进行节段性室壁运动分析。如果能检测到多巴酚丁胺或双嘧达莫诱发的短暂室壁运动异常，则将一个节段判定为病理性节段。为了与冠状动脉造影结果进行比较，将每个节段指定到一个冠状动脉灌注区域。在多巴酚丁胺和双嘧达莫输注期间，没有严重的副作用导致研究方案终止。多巴酚丁胺输注期间峰值心率与收缩压乘积显著高于双嘧达莫输注后（18493±4.311对12799±2.694毫米汞柱/分钟，p<0.001）。多巴酚丁胺和双嘧达莫-MRI对冠状动脉疾病（CAD）的总体敏感性分别为85%和84%。在单支血管疾病患者中，多巴酚丁胺和双嘧达莫-MRI观察到的节段性运动失调分别为73%和79%，在多支血管疾病患者中分别为100%和92%。对于左前降支冠状动脉狭窄，通过节段性室壁运动异常正确识别单个冠状动脉狭窄的比例分别为87%和81%；对于左旋支冠状动脉狭窄，分别为62%和86%；对于右冠状动脉狭窄，分别为78%和92%。总之，多巴酚丁胺和双嘧达莫-MRI耐受性良好且安全，是不依赖运动的检测和定位血流动力学显著冠状动脉狭窄的检查方法，诊断准确性相似，但多巴酚丁胺能更好地控制负荷强度和持续时间。
