多巴酚丁胺负荷超声心动图对心肌梗死患者冠状动脉狭窄的诊断准确性：左心室功能障碍程度和严重程度的影响

Accuracy of dobutamine stress echocardiography for the diagnosis of coronary artery stenosis in patients with myocardial infarction: the impact of extent and severity of left ventricular dysfunction.

作者信息

Elhendy A, yan Domburg R T, Roelandt J R, Geleijnse M L, Cornel J H, el-Said G M, Fioretti P M

机构信息

Thoraxcenter, University Hospital Rotterdam-Dijkzigt, The Netherlands.

出版信息

Heart. 1996 Aug;76(2):123-8. doi: 10.1136/hrt.76.2.123.

DOI:10.1136/hrt.76.2.123

PMID:8795473

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC484458/

Abstract

OBJECTIVES

To assess the value of dobutamine stress echocardiography (DSE) in the prediction of the extent and location of coronary artery stenosis in symptomatic patients with old myocardial infarction and to study the impact of the severity of resting wall motion abnormalities (WMA) on the diagnostic accuracy of the test.

PATIENTS

One hundred and thirty two symptomatic patients with old myocardial infarction.

METHODS

DSE (up to 40 micrograms/kg/min, with atropine up to 1 mg) was performed in all patients. Ischaemia was defined as new or worsened WMA. For each coronary artery, regional wall motion in the corresponding territory was classified as normal, mildly, moderately, or severely impaired according to the wall motion score index. Significant coronary stenosis was defined as > or = 50% diameter stenosis.

RESULTS

A positive DSE for ischaemia occurred in 87 of 111 patients with and three of 21 patients without coronary artery stenosis (sensitivity = 78%; CI 71 to 86, specificity = 86%; CI 79 to 92, accuracy = 80%; CI 73 to 87). The accuracy for the diagnosis of individual coronary stenosis was 69% in the presence of normal wall motion and 74%, 74%, and 61% respectively when there was mild, moderate, and severe WMA in the corresponding territories (P = NS). The sensitivity was higher in presence of mild or moderate WMA (73%) than with normal wall motion (53%) or severe WMA (56%, P < 0.05 in both). In territories subtended by a stenotic artery, the regional wall motion score index was not different with or without ischaemia.

CONCLUSION

DSE had a good overall accuracy for the diagnosis of coronary artery stenosis in symptomatic patients with old myocardial infarction. The presence of resting WMA did not limit DSE as a method of eliciting myocardial ischaemia and diagnosing significant coronary artery stenosis in patients with old myocardial infarctions.

摘要

目的

评估多巴酚丁胺负荷超声心动图（DSE）对有症状的陈旧性心肌梗死患者冠状动脉狭窄范围及部位的预测价值，并研究静息壁运动异常（WMA）严重程度对该检查诊断准确性的影响。

患者

132例有症状的陈旧性心肌梗死患者。

方法

所有患者均接受DSE检查（多巴酚丁胺剂量可达40微克/千克/分钟，阿托品剂量可达1毫克）。缺血定义为新出现或加重的WMA。对于每支冠状动脉，根据壁运动评分指数将相应区域的壁运动分为正常、轻度、中度或重度受损。显著冠状动脉狭窄定义为直径狭窄≥50%。

结果

111例有冠状动脉狭窄的患者中87例DSE缺血阳性，21例无冠状动脉狭窄的患者中3例阳性（敏感性=78%；可信区间71%至86%，特异性=86%；可信区间79%至92%，准确性=80%；可信区间73%至87%）。相应区域壁运动正常时，诊断单支冠状动脉狭窄的准确性为69%，存在轻度、中度和重度WMA时分别为74%、74%和61%（P=无显著性差异）。轻度或中度WMA时的敏感性（73%）高于壁运动正常（53%）或重度WMA（56%，两者P均<0.05）。在狭窄动脉供血区域，有无缺血时区域壁运动评分指数无差异。