Dubrey S, Huehns T Y, Parker S, Jewkes R F, Noble M I
Department of Academic Medicine, Charing Cross and Westminster Medical School, London, UK.
Int J Cardiol. 1995 Aug;51(1):5-14. doi: 10.1016/0167-5273(95)02374-6.
Change in the acceleration of aortic blood flow with stress testing is reported to reflect the presence of myocardial ischaemia. We studied its clinical usefulness when compared with dipyridamole thallium scintigraphy in 101 patients, of whom 64 had coronary angiography. Maximum aortic acceleration increased after dipyridamole (P < 0.0001), although no correlation existed between the aortic acceleration and evidence of thallium perfusion abnormalities. For the patients who had angiography, the increase in aortic acceleration was similar for those with no significant coronary stenoses, single vessel or multi-vessel disease. Compared with coronary angiography, Doppler measurement of maximum aortic acceleration had a sensitivity of 92% and a specificity of 37% for the detection of coronary artery disease. When patients with previous myocardial infarction or left ventricular dysfunction were excluded, there was still no relationship between the maximum aortic acceleration and the presence of coronary artery disease. We conclude that changes in the acceleration of aortic blood flow after dipyridamole stressing do not predict the presence or severity of coronary artery disease as measured from perfusion defects at thallium scintigraphy or by coronary angiography. We have observed a wide variability of aortic maximum acceleration in the evaluation of myocardial ischaemia, which we feel introduces serious limitations to its use in routine clinical practice.
据报道，应激试验时主动脉血流加速度的变化可反映心肌缺血的存在。我们对101例患者进行了研究，比较了其与双嘧达莫铊闪烁显像的临床实用性，其中64例患者进行了冠状动脉造影。双嘧达莫给药后主动脉最大加速度增加（P < 0.0001），尽管主动脉加速度与铊灌注异常证据之间无相关性。对于进行了血管造影的患者，无明显冠状动脉狭窄、单支血管或多支血管病变患者的主动脉加速度增加情况相似。与冠状动脉造影相比，多普勒测量主动脉最大加速度检测冠状动脉疾病的敏感性为92%，特异性为37%。排除既往有心肌梗死或左心室功能障碍的患者后，主动脉最大加速度与冠状动脉疾病的存在仍无关系。我们得出结论，双嘧达莫应激后主动脉血流加速度的变化不能预测铊闪烁显像灌注缺损或冠状动脉造影所测量的冠状动脉疾病的存在或严重程度。在评估心肌缺血时，我们观察到主动脉最大加速度存在很大差异，我们认为这严重限制了其在常规临床实践中的应用。
