Parthenakis F I, Karidis K S, Zuridakis G, Kanoupakis E M, Chlouverakis G I, Vardas P E
Cardiology Department, University Hospital of Heraklion, Crete, Greece.
Coron Artery Dis. 1997 Jul;8(7):449-54. doi: 10.1097/00019501-199707000-00007.
To evaluate the usefulness of the Doppler assessment of left ventricular diastolic functioning during dipyridamole-induced ischaemia in patients with coronary artery disease (CAD).
We studied 28 patients with angiographically proven CAD [18 men, aged 62 +/- 7 years (mean +/- SD)] and 18 normal subjects (12 men, aged 59 +/- 7.5 years). Two-dimensional and transmitral flow Doppler echocardiography studies were performed at baseline and after intravenous administration of a high dose of dipyridamole (0.84 mg/kg during 10 min). Left ventricular wall motion was evaluated by two-dimensional Doppler echocardiography, with the left ventricle divided into a 16-segment model, whereas peak velocities of early and late diastolic flow, the early:late diastolic flow ratio and the deceleration rate of early diastolic flow were determined from transmitral flow Doppler echocardiography.
Sixteen patients developed new wall-motion abnormalities (WMA), whereas the remaining 12 patients and the controls did not. Multivariate logistic regression analysis was performed to identify which of the parameters had independent diagnostic value for revealing CAD. WMA was entered at the first step and yielded a 57% sensitivity and 100% specificity; the changes in deceleration rate were entered as the second step, which improved the sensitivity to 85.5%, and reduced the specificity to 83% and raised the overall accuracy to 85% from 70% for WMA alone. More specifically, the sensitivity improved from 37.5, 63.5 and 65.5% to 62.5, 91 and 100%, respectively, for patients with one-, two- and three-vessel disease. The cut-off value of the change in deceleration rate was 7%.
Patients could be classified as having CAD either if they developed new WMA or if the deceleration rate of early diastolic flow during dipyridamole-stress echocardiography increased by more than 7% compared with the rest value.
评估双嘧达莫诱发心肌缺血期间，多普勒评估冠状动脉疾病（CAD）患者左心室舒张功能的效用。
我们研究了28例经血管造影证实患有CAD的患者[18例男性，年龄62±7岁（均值±标准差）]以及18名正常受试者（12例男性，年龄59±7.5岁）。在基线状态及静脉注射高剂量双嘧达莫（10分钟内0.84mg/kg）后，进行二维及经二尖瓣血流多普勒超声心动图检查。通过二维多普勒超声心动图评估左心室壁运动，将左心室分为16节段模型，而舒张早期和晚期血流峰值速度、舒张早期：晚期血流比值以及舒张早期血流减速速率则由经二尖瓣血流多普勒超声心动图测定。
16例患者出现新的室壁运动异常（WMA），而其余12例患者及对照组未出现。进行多因素逻辑回归分析，以确定哪些参数对揭示CAD具有独立诊断价值。第一步纳入WMA，其敏感性为57%，特异性为100%；第二步纳入减速速率变化，这将敏感性提高至85.5%，特异性降至83%，总体准确率从仅WMA时的70%提高至85%。更具体而言，单支血管病变、双支血管病变和三支血管病变患者的敏感性分别从37.5%、63.5%和65.5%提高至62.5%、91%和100%。减速速率变化的截断值为7%。
若患者出现新的WMA，或在双嘧达莫负荷超声心动图检查期间舒张早期血流减速速率较静息值增加超过7%，则可归类为患有CAD。
