Rallidis L, Cokkinos P, Tousoulis D, Nihoyannopoulos P
Department of Medicine, Hammersmith Hospital, London, England, United Kingdom.
J Am Coll Cardiol. 1997 Dec;30(7):1660-8. doi: 10.1016/s0735-1097(97)00376-8.
We sought to compare the magnitude of ischemia precipitated by both treadmill exercise and dobutamine stress echocardiography.
Although it is alleged that dobutamine stress produces ischemia similar in degree and extent to that produced during treadmill exercise, a direct comparison with treadmill exercise, the most common form of exercise, has not been performed.
Eighty-five consecutive patients with known coronary artery disease underwent both stress tests on the same day, in random order.
Sixty-two patients (73%) had positive results on exercise echocardiography compared with 53 (62%) who had positive results on dobutamine stress (p = NS). Of the 53 patients with positive dobutamine test results, wall motion abnormalities appeared after the addition of atropine in 35 patients (66%). During dobutamine infusion, 22 patients (26%) had a hypotensive response that was reversed in 16 by prompt administration of atropine. At peak dobutamine-atropine stress, heart rate was higher than that at peak exercise (p < 0.001), whereas systolic blood pressure and rate-pressure product were higher at peak exercise than at peak dobutamine-atropine stress (p = 0.0001). In the 53 patients with positive results on both tests, peak wall motion score index was greater with treadmill exercise than with dobutamine-atropine infusion ([mean +/- SD] 1.73 +/- 0.45 vs. 1.57 +/- 0.44, p < 0.001).
Echocardiography immediately after treadmill exercise induces a greater ischemic burden than dobutamine-atropine infusion. In the clinical setting, exercise echocardiography should therefore be chosen over dobutamine echocardiography for diagnosing ischemia, when possible. When dobutamine echocardiography is used as an alternative modality, maximal heart rate should always be achieved by the addition of atropine.
我们试图比较平板运动和多巴酚丁胺负荷超声心动图诱发的缺血程度。
尽管据称多巴酚丁胺负荷试验产生的缺血在程度和范围上与平板运动时相似，但尚未与最常见的运动形式平板运动进行直接比较。
85例连续的已知冠心病患者在同一天按随机顺序接受两种负荷试验。
62例患者（73%）运动超声心动图结果为阳性，而多巴酚丁胺负荷试验阳性的患者有53例（62%）（p = 无显著性差异）。在53例多巴酚丁胺试验结果阳性的患者中，35例（66%）在加用阿托品后出现室壁运动异常。在多巴酚丁胺输注过程中，22例患者（26%）出现低血压反应，其中16例通过及时给予阿托品得以纠正。在多巴酚丁胺 - 阿托品负荷试验峰值时，心率高于运动峰值时（p < 0.001），而收缩压和心率 - 血压乘积在运动峰值时高于多巴酚丁胺 - 阿托品负荷试验峰值时（p = 0.0001）。在两种试验结果均为阳性的53例患者中，平板运动时的峰值室壁运动评分指数大于多巴酚丁胺 - 阿托品输注时（[均值±标准差]1.73±0.45对1.57±0.44，p < 0.001）。
平板运动后立即进行超声心动图检查诱发的缺血负荷比多巴酚丁胺 - 阿托品输注更大。因此，在临床情况下，诊断缺血时，若可能应选择运动超声心动图而非多巴酚丁胺超声心动图。当使用多巴酚丁胺超声心动图作为替代方法时，应始终通过加用阿托品使心率达到最大值。
