数字仰卧位踏车负荷超声心动图：一种评估冠状动脉疾病的新技术。

Digital supine bicycle stress echocardiography: a new technique for evaluating coronary artery disease.

作者信息

Hecht H S, DeBord L, Shaw R, Dunlap R, Ryan C, Stertzer S H, Myler R K

机构信息

San Francisco Heart Institute, Seton Medical Center, Daly City, California 94015.

出版信息

J Am Coll Cardiol. 1993 Mar 15;21(4):950-6. doi: 10.1016/0735-1097(93)90352-2.

DOI:10.1016/0735-1097(93)90352-2

PMID:8450164

Abstract

OBJECTIVES

The objective of this study was to determine the accuracy of digital supine bicycle stress echocardiography, a new technique for evaluating coronary artery disease during peak exercise.

BACKGROUND

Prior stress echocardiographic techniques have not utilized peak exercise imaging to determine the extent and location of coronary artery disease.

METHODS

Two-hundred twenty-two patients were studied: 180 underwent both supine bicycle stress echocardiography and coronary arteriography; 42 had a < 5% likelihood of disease. Forty-three patients had normal coronary arteries, 55 had single-vessel, 42 had double-vessel and 40 had triple-vessel coronary artery disease.

RESULTS

Supine bicycle stress echocardiography was 93% sensitive, 86% specific and 92% accurate for identifying patients with coronary artery disease irrespective of prior myocardial infarction or achievement of > or = 85% maximal predicted heart rate. The "normalcy" rate in the low probability group was 100%. Supine bicycle stress echocardiography was 87% sensitive, 89% specific and 88% accurate for specific vessel identification. The sensitivity was greatest for the left anterior descending compared with the right coronary artery and the left circumflex coronary artery (95% vs. 81% vs. 78%, p < 0.01) and for vessels in patients with double- and triple-vessel compared with single-vessel disease (90% vs. 89% vs. 78%, p < 0.05). The procedure was significantly more sensitive for detection of vessels with 90% to 100% compared with 50% to 70% diameter stenosis (91% vs. 81%, p < 0.05) and was 88% correct in the prediction of multivessel disease.

CONCLUSIONS

Supine bicycle stress echocardiography is a highly accurate tool for evaluating coronary artery disease, identifying both the patient with coronary artery disease and the location and extent of disease.

摘要

目的

本研究的目的是确定数字式仰卧位踏车负荷超声心动图的准确性，这是一种用于评估运动高峰时冠状动脉疾病的新技术。

背景

既往的负荷超声心动图技术未利用运动高峰成像来确定冠状动脉疾病的范围和位置。

方法

对222例患者进行了研究：180例患者同时接受了仰卧位踏车负荷超声心动图和冠状动脉造影检查；42例患者患疾病的可能性小于5%。43例患者冠状动脉正常，55例患者为单支血管病变，42例患者为双支血管病变，40例患者为三支血管病变。

结果

无论患者既往有无心肌梗死或是否达到≥85%的最大预测心率，仰卧位踏车负荷超声心动图识别冠状动脉疾病患者的敏感性为93%，特异性为86%，准确性为92%。低概率组的“正常”率为100%。仰卧位踏车负荷超声心动图识别特定血管的敏感性为87%，特异性为89%，准确性为88%。与右冠状动脉和左旋支冠状动脉相比，左前降支的敏感性最高（95%对81%对78%，p<0.01），双支和三支血管病变患者的血管敏感性高于单支血管病变患者（90%对89%对78%，p<0.05）。与直径狭窄50%至70%的血管相比，该检查对检测直径狭窄90%至100%的血管敏感性显著更高（91%对81%，p<0.05），预测多支血管病变的正确率为88%。