Scandura S, Felis S, Barbagallo G, Deste W, Drago A, D'Aleo P, Calvi V, Giuffrida G
Istituto di Cardiologia, Università degli Studi, Catania.
Cardiologia. 1997 Mar;42(3):287-92.
Coronary artery disease (CAD) is one of the main causes of cardiovascular morbility and mortality. Actual research lines are directed towards the discovery of silent CAD before hard events as myocardial infarction and sudden death. Dobutamine stress echocardiography is an useful method to assess patients with suspected CAD who, are not able to stand an effort because of physical reasons. During the test, hypotension and/or bradycardia may occur and may cause interruption of the test. The aim of our study was to consider prevalence, meaning and clinical implications of hypotensive, sometimes associated to bradycardia, during dobutamine stress echocardiography. From April 1994 to June 1996, 363 consecutive patients (267 men and 96 women with an average age of 59.3 +/- 10 year) were examined because of suspected or known ischemic cardiopathy. All patients underwent dobutamine stress echocardiography and coronary arteriography. Neither hypotension nor bradycardia was noted in 285 of our patients (78.51%), while in the remaining 78 patients (21.48%) there was a pressure drop > or = 20 mmHg; bradycardia appeared in 6 patients. The study shows that it does not exist a statistically significant difference between the percentage of the patients with CAD of the control group and those of the hypotensive group (91.9 vs 83.3%, NS). As for the changes in well motion score index, there was not a statistically significant difference between patients improved score index in the control group and in the hypotensive group (80 vs 74.3%, NS). The 6 patients with hypotension and bradycardia had normal coronary arteries. In the light of these results hypotension, alone or associated with bradycardia, should not be considered as a negative prognostic factor and should not induce to the interruption of the dobutamine stress echocardiography.
冠状动脉疾病（CAD）是心血管疾病发病率和死亡率的主要原因之一。当前的研究方向是在心肌梗死和猝死等严重事件发生之前发现无症状CAD。多巴酚丁胺负荷超声心动图是评估因身体原因无法耐受运动的疑似CAD患者的一种有用方法。在检查过程中，可能会出现低血压和/或心动过缓，并可能导致检查中断。我们研究的目的是探讨多巴酚丁胺负荷超声心动图检查期间低血压（有时伴有心动过缓）的发生率、意义及临床影响。1994年4月至1996年6月，连续对363例患者（267例男性和96例女性，平均年龄59.3±10岁）进行检查，这些患者均因疑似或已知缺血性心脏病就诊。所有患者均接受了多巴酚丁胺负荷超声心动图检查和冠状动脉造影。285例患者（78.51%）未出现低血压和心动过缓，而其余78例患者（21.48%）出现了血压下降≥20 mmHg；6例患者出现心动过缓。研究表明，对照组CAD患者百分比与低血压组CAD患者百分比之间不存在统计学显著差异（91.9%对83.3%，无显著性差异）。至于室壁运动评分指数的变化，对照组和低血压组评分指数改善的患者之间不存在统计学显著差异（80%对74.3%，无显著性差异）。6例出现低血压和心动过缓的患者冠状动脉正常。鉴于这些结果，低血压单独或与心动过缓相关，不应被视为不良预后因素，也不应导致多巴酚丁胺负荷超声心动图检查中断。
