Guadalajara Boo J F, Galván Montiel O, Marrufo Hernández R, Cervantes Escárcega J L, Huerta Hernández D
Instituto Nacional de Cardiologia Ignacio Chávez.
Arch Inst Cardiol Mex. 1995 Jul-Aug;65(4):330-41.
We studied 300 patients (p) with dobutamine stress echocardiography (DSE) and atropine. The indication were chest pain, abnormal electrocardiogram (ECG), abnormal stress electrocardiogram with or without chest pain or any combination of these. The DSE was evaluated with digitized imaging in long and short parasternal views and apical four and two chambers views before and during dobutamine test with simultaneous side by side display. In 21 p (56.7%) we found positive concordance in diagnosis of coronary artery disease (CAD) between coronary arteriography (CA) and DSE. In 13 of 37 p the concordance was negative by the two methods (35.1%); then the DSE was capable correctly predict in 34 p (91%). The abnormal CA and normal DSE were found in one p (4.5%) with 90% obstruction of a small diagonal vessel. In two women DSE was abnormal with inferior hypokinesis (13.3%) and the CA was normal. In 43 p (14.3%) ECG and DSE were positive for myocardial ischemia (MI); negative concordance of both procedures was found in 203 p (67.6%). ECG was abnormal and DSE normal in 46 p (15.3%) 61 p (20.3%) with DSE abnormal in 8 p (2.6%) 61 p (20.3%) had arrhythmias; in 55 (18.3%) premature ventricular contractions, one p with ventricular tachycardia (0.33%); 7.3% of them required endovenous lidocaine. Chest pain was present in 22 p (7.3%) and the treatment waqs sublingual isosorbide; hypotension appeared in 27 p (9%) and were treated with saline infusion. Hypertensive response was found in two p (0.66%) and were treated with nifedipine and smolol. We concluded that DSE with atropine has high sensibility (95.5%) and specificity (86.6%) in the diagnosis of ischemic heart disease. The adverse effects are nondangerous and easily resolved with medical treatment.
我们对300例接受多巴酚丁胺负荷超声心动图（DSE）和阿托品检查的患者进行了研究。适应症包括胸痛、心电图（ECG）异常、有或无胸痛的异常负荷心电图或这些情况的任意组合。在多巴酚丁胺试验前和试验期间，通过数字化成像在胸骨旁长轴和短轴视图以及心尖四腔和两腔视图中对DSE进行评估，并同时进行并排显示。在21例患者（56.7%）中，我们发现冠状动脉造影（CA）和DSE在冠状动脉疾病（CAD）诊断方面存在阳性一致性。在37例患者中的13例中，两种方法的一致性为阴性（35.1%）；然后DSE能够正确预测34例患者（91%）。在1例患者（4.5%）中发现CA异常而DSE正常，该患者一条小对角支血管阻塞90%。在两名女性中，DSE显示下壁运动减弱异常（13.3%）而CA正常。在43例患者（14.3%）中，ECG和DSE显示心肌缺血（MI）呈阳性；在203例患者（67.6%）中发现两种检查结果均为阴性一致性。46例患者（15.3%）中ECG异常而DSE正常，61例患者（20.3%）中DSE异常，8例患者（2.6%）出现心律失常；61例患者（20.3%）中有55例（18.3%）出现室性早搏，1例患者（0.33%）出现室性心动过速；其中7.3%的患者需要静脉注射利多卡因。22例患者（7.3%）出现胸痛，治疗方法为舌下含服异山梨酯；27例患者（9%）出现低血压，通过静脉输注生理盐水进行治疗。2例患者（0.66%）出现高血压反应，通过硝苯地平和索他洛尔进行治疗。我们得出结论，多巴酚丁胺联合阿托品的DSE在缺血性心脏病诊断中具有高敏感性（95.5%）和特异性（86.6%）。不良反应无危险性，通过药物治疗易于解决。
