Pingitore A, Picano E, Colosso M Q, Reisenhofer B, Gigli G, Lucarini A R, Petix N, Previtali M, Bigi R, Chiarandà G, Minardi G, de Alcantara M, Lowenstein J, Sclavo M G, Palmieri C, Galati A, Seveso G, Heyman J, Mathias W, Casazza F, Sicari R, Raciti M, Landi P, Marzilli M
Institute of Clinical Physiology, Consiglio Nazionale delle Ricerche (CNR), Pisa, Italy.
J Am Coll Cardiol. 1996 Apr;27(5):1164-70. doi: 10.1016/0735-1097(95)00586-2.
This study sought to compare, head to head, the two most popular pharmacologic stress echocardiographic tests--dipyridamole and dobutamine--with state of the art protocols in a large multicenter prospective study.
In the continuing quest for ideal diagnostic accuracy, pharmacologic stress echocardiography has quickly moved over the years from low to high dose regimens and is currently performed with atropine coadministration.
Dobutamine (up to 40 microgram/kg body weight per min) plus atropine (up to 1 mg over 4 h) and dipyridamole (up to 0.84 mg/kg per min over 10 h) plus atropine (up to 1 mg over 4 h) stress echocardiography was performed on different days, in random order and within 1 week in 360 patients with chest pain syndrome. Thirteen different echocardiographic laboratories, all fulfilling quality control criteria for stress echocardiographic reading, contributed to the study.
No major complications occurred during either test. The test was interrupted before achievement of predetermined end points for limiting side effects in 37 dobutamine-atropine and 7 dipyridamole-atropine stress echocardiographic studies (feasibility 90% vs. 98%, p < 0.01). Diagnostic accuracy was assessed in a subset of 110 patients with no obvious rest dyssynergy (akinesia or dyskinesia) who underwent coronary angiography independently of test results and within 1 week of testing. Significant coronary artery disease (> or = 50% diameter reduction in at least one major coronary vessel by quantitative coronary angiography) was found in 92 patients. Sensitivity for detection of coronary artery disease was 84% (77 of 92) for dobutamine-atropine and 82% (75 of 92) for dipyridamole-atropine stress echocardiography (p = NS), with a specificity of 89% (16 of 18) for dobutamine-atropine and 94% (17 of 18) for dipyridamole-atropine stress echocardiography (p = NS). A significant correlation was present between peak wall motion score index during dipyridamole-atropine and dobutamine-atropine stress echocardiography (r = 0.83, p < 0.0001).
Dobutamine-atropine and dipyridamole-atropine stress echocardiography are safe and feasible, although submaximal studies are more frequent with dobutamine. The two stresses have comparable accuracy in the detection of angiographically assessed coronary artery disease, although dobutamine is marginally more sensitive and dipyridamole marginally more specific. Stratification of the ischemic response in the space domain is also comparable with the two stresses.
在一项大型多中心前瞻性研究中，将两种最常用的药物负荷超声心动图检查——双嘧达莫和多巴酚丁胺——与先进方案进行直接比较。
为持续追求理想的诊断准确性，多年来药物负荷超声心动图已迅速从低剂量高高的剂量方案发展至高剂量方案，目前还联合使用阿托品。
对360例胸痛综合征患者在不同日期、随机顺序且在1周内分别进行多巴酚丁胺（最大剂量达每分钟40微克/千克体重）加阿托品（4小时内最大剂量达1毫克）负荷超声心动图检查以及双嘧达莫（10小时内最大剂量达每分钟0.84毫克/千克）加阿托品（4小时内最大剂量达1毫克）负荷超声心动图检查。13个不同的超声心动图实验室均符合负荷超声心动图解读的质量控制标准，参与了本研究。
两种检查期间均未发生重大并发症。在37例多巴酚丁胺 - 阿托品和7例双嘧达莫 - 阿托品负荷超声心动图检查中，因限制副作用在达到预定终点前中断检查（可行性分别为90%和98%，p<0.01）。在110例静息时无明显运动失调（运动减弱或运动障碍）的患者亚组中评估诊断准确性，这些患者在检查后1周内独立于检查结果接受了冠状动脉造影。通过定量冠状动脉造影发现92例患者存在显著冠状动脉疾病（至少一支主要冠状动脉血管直径减少≥50%）。多巴酚丁胺 - 阿托品负荷超声心动图检测冠状动脉疾病的敏感性为84%（92例中的77例），双嘧达莫 - 阿托品负荷超声心动图为82%（92例中的75例）（p = 无显著差异），多巴酚丁胺 - 阿托品负荷超声心动图的特异性为89%（18例中的16例），双嘧达莫 - 阿托品负荷超声心动图为94%（18例中的17例）（p = 无显著差异）。双嘧达莫 - 阿托品和多巴酚丁胺 - 阿托品负荷超声心动图期间的峰值壁运动评分指数之间存在显著相关性（r = 0.83，p<0.0001）。
多巴酚丁胺 - 阿托品和双嘧达莫 - 阿托品负荷超声心动图检查安全可行，不过多巴酚丁胺检查未达最大剂量的情况更常见。两种负荷检查在检测经血管造影评估的冠状动脉疾病方面准确性相当，尽管多巴酚丁胺的敏感性略高，双嘧达莫的特异性略高。两种负荷检查在空间域的缺血反应分层也相当。
