Ginzton L E, Pool P E, Appleton C, Mohiuddin S, Robertson W S, Ismail G D, Bach D S, Armstrong W F
Division of Cardiology, Harbor-UCLA Medical Center, Torrance 90509, USA.
Int J Cardiol. 1996 Nov 15;57(1):81-9. doi: 10.1016/s0167-5273(96)02765-9.
Arbutamine is a new beta-adrenergic agonist with potent chronotropic and inotropic properties developed to pharmacologically induce stress. A prospective trial was conducted in five centers with a total enrolment of 45 patients with angiographically documented coronary artery disease. The primary purpose of the trial was to compare the efficacy of arbutamine with symptom-limited exercise in provoking clinical (angina), electrocardiographic (> or = 0.1 mV ST depression) and echocardiographic (induced wall motion abnormality) evidence of transient stress-induced ischemia. The secondary purpose was to assess the safety of arbutamine in patients with coronary artery disease. Ischemia was induced at a lower heart rate, systolic blood pressure and pressure-rate product during arbutamine infusion than during exercise. Using angina and/or electrocardiographic evidence of ischemia, arbutamine was more sensitive than exercise in detecting myocardial ischemia (77 vs. 58%, P = 0.021). Using echocardiography, the sensitivity for inducing wall motion abnormalities was 88% with arbutamine and 79% with exercise (P = not significant). Echocardiography in combination with angina and/or electrocardiographic evidence increased the sensitivity to 94% using arbutamine and to 88% with exercise. For the patients with multivessel disease, the sensitivity was 97% and 91%, respectively. No serious adverse events, either cardiac or noncardiac, were associated with arbutamine, and no patient had prolonged ischemia. Although exercise is the preferred method of stress for patients who are able to exercise adequately, arbutamine is at least as sensitive as exercise for the diagnosis of myocardial ischemia, and appears to be a safe and effective alternative to exercise testing in patients unable to exercise adequately.
阿巴胺是一种新型β肾上腺素能激动剂，具有强大的变时性和变力性特性，用于药理学诱导应激。在五个中心进行了一项前瞻性试验，共纳入45例经血管造影证实患有冠状动脉疾病的患者。该试验的主要目的是比较阿巴胺与症状限制性运动在诱发临床（心绞痛）、心电图（≥0.1 mV ST段压低）和超声心动图（诱发室壁运动异常）方面的短暂应激性缺血证据的疗效。次要目的是评估阿巴胺在冠状动脉疾病患者中的安全性。与运动期间相比，阿巴胺输注期间诱发缺血时的心率、收缩压和压力-心率乘积较低。使用心绞痛和/或缺血的心电图证据，阿巴胺在检测心肌缺血方面比运动更敏感（77%对58%，P = 0.021）。使用超声心动图，阿巴胺诱发室壁运动异常的敏感性为88%，运动为79%（P无显著性差异）。超声心动图结合心绞痛和/或心电图证据，使用阿巴胺时敏感性提高到94%，运动时提高到88%。对于多支血管病变患者，敏感性分别为97%和91%。阿巴胺未引发任何严重的心脏或非心脏不良事件，也没有患者出现长时间缺血。尽管运动是能够充分运动的患者首选的应激方法，但阿巴胺在诊断心肌缺血方面至少与运动一样敏感，对于无法充分运动的患者，似乎是运动试验的一种安全有效的替代方法。
