Wagner S, Mohr-Kahaly S, Nixdorff U, Kölsch B, Menzel T, Wittlich N, Meinert R, Meyer J
II. Medizinische Klinik Johannes-Gutenberg-Universität Mainz.
Z Kardiol. 1996 Aug;85(8):588-95.
We used a standardized questionnaire to assess physical and mental distress caused by dobutamine stress echocardiography (DSE). The examination was performed according to a standardized protocol (5-40 micrograms/kg/min including atropine). 91 patients (pts), 68 men (62 +/- 9 years), 23 women (65 +/- 7 years) were asked to quantify the severity of the following symptoms: palpitations, anxiety, headache, nausea, discomfort of left lateral position, angina pectoris and dyspnea. Numbers on a rating scale from 1-10 defined the degree of distress. Absence of a symptom equalled mark, 1, slight expression marks 2-4. Moderate expression was defined by marks 5-7 and very strong expression by marks 8-10.
86% of pts felt affected by one or more symptoms to a slight to moderate extent (mark 4 +/- 2.17). Palpitations were felt by 85% of the pts (mark 6 +/- 2.83), anxiety by 42% (mark 3 +/- 2.5), headache by 50% (3 +/- 2.54), nausea by 20% (2 +/- 1.72), angina pectoris by 42% (3 +/- 2.5), dyspnea by 30% (2 +/- 2.42) and discomfort of left lateral recumbent position by 43% (mark 3 +/- 2.59). 43 pts underwent coronary angiography. The negative predictive value of DSE to identify pts without a coronary artery stenosis extending a 50% diameter reduction was 85% for the 16 pts who reached their individual submaximal heart rate compared to 60% for those 27 pts who did not reach it. Unspecific symptoms led to test termination in these pts. The positive predictive values were comparable (89 and 94%).
DSE causes physical and mental distress. If symptoms lead to test termination before age corrected submaximal heart rate is reached, normal wall motion does not exclude significant coronary artery disease.
我们使用标准化问卷评估多巴酚丁胺负荷超声心动图（DSE）引起的身心不适。检查按照标准化方案进行（5 - 40微克/千克/分钟，包括阿托品）。91例患者（pts），68名男性（62±9岁），23名女性（65±7岁）被要求量化以下症状的严重程度：心悸、焦虑、头痛、恶心、左侧卧位不适、心绞痛和呼吸困难。1 - 10的评分量表数字定义了不适程度。无症状记为1分，轻微表现记为2 - 4分。中度表现定义为5 - 7分，非常强烈的表现定义为8 - 10分。
86%的患者感到受到一种或多种症状的轻微至中度影响（评分为4±2.17）。85%的患者感到心悸（评分为6±2.83），42%的患者感到焦虑（评分为3±2.5），50%的患者感到头痛（3±2.54），20%的患者感到恶心（2±1.72），42%的患者感到心绞痛（3±2.5），30%的患者感到呼吸困难（2±2.42），43%的患者感到左侧卧位不适（评分为3±2.59）。43例患者接受了冠状动脉造影。对于16例达到个人次极量心率的患者，DSE识别无冠状动脉狭窄（直径减少50%）患者的阴性预测值为85%，而对于27例未达到次极量心率的患者，该值为60%。非特异性症状导致这些患者的检查终止。阳性预测值相当（89%和94%）。
DSE会引起身心不适。如果症状在达到年龄校正后的次极量心率之前导致检查终止，正常的室壁运动并不能排除严重冠状动脉疾病。
