Djordjevic-Dikic A D, Ostojic M C, Beleslin B D, Stepanovic J, Petrasinovic Z, Babic R, Stojkovic S M, Stankovic G, Nedeljkovic M, Nedeljkovic I, Kanjuh V
University Institute for Cardiovascular Diseases, Department of Diagnostic and Catheterization Laboratories, Belgrade, Yugoslavia.
J Am Coll Cardiol. 1996 Dec;28(7):1689-95. doi: 10.1016/S0735-1097(96)00374-9.
The aim of this study was to assess the tolerability and incremental diagnostic value of high adenosine doses in stress echocardiography testing in patients with coronary artery disease (CAD).
In comparison with other pharmacologic stress echocardiography tests, standard dose adenosine stress has sub-optimal sensitivity for detecting milder forms of CAD.
Adenosine stress echocardiography was performed in 58 patients using a starting dose of 100 micrograms/kg body weight per min over 3 min followed by 140 micrograms/kg per min over 4 min (standard dose). If no new wall motion abnormality appeared, the dose was increased to 200 micrograms/kg per min over 4 min (high dose). All patients underwent coronary angiography. Significant CAD was defined as > or = 50% diameter stenosis in at least one major coronary artery. Thirty-three patients had one-vessel and seven had multivessel CAD. Coronary angiographic findings were normal in 18 patients.
The high adenosine dose caused a slight but significant increase over baseline values in rate-pressure product. Limiting side effects occurred in two patients during the standard dose protocol and in one patient receiving the high dose regimen. The test was stopped in 30 patients after the standard adenosine dose regimen because of a provoked new wall motion abnormality. The sensitivity of adenosine echocardiography with the standard dose was 75% (95% confidence interval [CI] 63% to 87%). After completion of the standard dose protocol, 28 patients continued testing with the high dose adenosine protocol. The overall sensitivity of adenosine echocardiography, calculated as cumulative, increased to 92% (95% CI 84% to 100%) with the high dose (p < 0.05). The specificity of adenosine testing was 100% and 88%, respectively, with the standard and high dose regimen (p = 0.617).
We believe that use of a higher than usual adenosine dose protocol for stress testing may improve the diagnostic value of adenosine echocardiography, mainly by increasing sensitivity in patients with single-vessel disease without deterioration of the safety profile and with only a mild reduction in specificity.
本研究旨在评估高剂量腺苷在冠状动脉疾病（CAD）患者的负荷超声心动图检查中的耐受性及增加的诊断价值。
与其他药物负荷超声心动图检查相比，标准剂量腺苷负荷对检测较轻形式的CAD敏感性欠佳。
对58例患者进行腺苷负荷超声心动图检查，起始剂量为每分钟100微克/千克体重，持续3分钟，随后4分钟内为每分钟140微克/千克体重（标准剂量）。如果未出现新的室壁运动异常，则将剂量增加至4分钟内每分钟200微克/千克体重（高剂量）。所有患者均接受冠状动脉造影。显著CAD定义为至少一支主要冠状动脉直径狭窄≥50%。33例患者为单支血管病变，7例为多支血管病变。18例患者冠状动脉造影结果正常。
高剂量腺苷使心率-血压乘积较基线值有轻微但显著的升高。在标准剂量方案期间，2例患者出现了限制性副作用，1例接受高剂量方案的患者也出现了副作用。在标准腺苷剂量方案后，30例患者因诱发新的室壁运动异常而停止检查。标准剂量腺苷超声心动图的敏感性为75%（95%置信区间[CI]63%至87%）。在完成标准剂量方案后，28例患者继续进行高剂量腺苷方案检查。高剂量时，腺苷超声心动图的总体敏感性（计算为累积值）增加至92%（95%CI84%至100%）（p<0.05）。标准剂量和高剂量方案下腺苷检查的特异性分别为100%和88%（p=0.617）。
我们认为，在负荷试验中使用高于常规的腺苷剂量方案可能会提高腺苷超声心动图的诊断价值，主要是通过提高单支血管病变患者的敏感性，且不降低安全性，仅使特异性略有降低。
