Rambaldi R, Poldermans D, Fioretti P M, ten Cate F J, Vletter W B, Bax J J, Roelandt J R
Thoraxcenter, University Hospital Rotterdam-Dijkzigt and Erasmus University, Rotterdam, The Netherlands.
Am J Cardiol. 1998 Jun 15;81(12):1411-5. doi: 10.1016/s0002-9149(98)00208-2.
To study the feasibility and diagnostic accuracy of right coronary artery (RCA) narrowing by right ventricular (RV) pulse-wave Doppler tissue sampling during dobutamine stress echocardiography (DSE), 30 patients (mean age 55 +/- 9.5 years, 26 men) with suspected coronary artery disease underwent DSE (up to 40 microg/kg/min with additional atropine during submaximum heart rate responses). Pulse-wave Doppler tissue sampling of RV free walls close to the tricuspid annulus was performed in the apical 4-chamber view. The maximum velocity during the ejection phase, early, and late diastole was measured. Data from 5 consecutive beats were averaged. The measurements were repeated at rest, at low dose (10 microg/kg/min), and at peak dobutamine stress. The results were evaluated for the prediction of significant proximal or medium RCA narrowing (> or = 50% diameter stenosis, assessed by quantitative coronary angiography within the previous 3 months). A progressive increase of the ejection phase velocity (> 25% between 10 microg/kg/min and peak stress) was predictive of a normal RCA, whereas a blunted increase and/or decrease (< 25% of increase) was predictive of significant RCA narrowing: sensitivity (95% confidence intervals): 82% (68 to 96), specificity: 78% (67 to 93), positive predictive value: 69% (52 to 86), negative predictive value: 88% (75 to 100), accuracy: 79% (65 to 94). Pulse-wave Doppler tissue sampling provided analyzable data in 100%, whereas the visual assessment of gray-scale images was possible only in 90%. Thus, in patients with suspected RCA narrowing, pulse-wave Doppler tissue sampling during DSE was able to diagnose significant RCA narrowing.
为研究多巴酚丁胺负荷超声心动图（DSE）期间右心室（RV）脉冲波多普勒组织取样检测右冠状动脉（RCA）狭窄的可行性及诊断准确性，30例疑诊冠心病患者（平均年龄55±9.5岁，26例男性）接受了DSE检查（最大剂量达40μg/kg/min，在心率未达最大值时加用阿托品）。在心尖四腔心切面，对靠近三尖瓣环的右心室游离壁进行脉冲波多普勒组织取样。测量射血期、舒张早期和舒张晚期的最大速度。取连续5个心动周期的数据进行平均。在静息状态、低剂量（10μg/kg/min）和多巴酚丁胺负荷峰值时重复测量。评估测量结果对显著近端或中段RCA狭窄（直径狭窄≥50%，在前3个月内通过定量冠状动脉造影评估）的预测价值。射血期速度逐渐增加（10μg/kg/min至负荷峰值之间增加>25%）提示RCA正常，而增加不明显和/或下降（增加<25%）提示RCA有显著狭窄：敏感性（95%可信区间）：82%（68%至96%），特异性：78%（67%至93%），阳性预测值：69%（52%至86%），阴性预测值：88%（75%至100%），准确性：79%（65%至94%）。脉冲波多普勒组织取样100%可提供可分析数据，而灰阶图像的视觉评估仅90%可行。因此，在疑诊RCA狭窄的患者中，DSE期间的脉冲波多普勒组织取样能够诊断显著的RCA狭窄。
