Miyazono Y, Kisanuki A, Toyonaga K, Matsushita R, Otsuji Y, Arima S, Nakao S, Tanaka H
First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Kagoshima City, Japan.
Am J Cardiol. 1998 Aug 1;82(3):290-4. doi: 10.1016/s0002-9149(98)00345-2.
There have been few studies on adenosine triphosphate (AT) stress echocardiography. The AT stress test may have fewer adverse effects than the adenosine stress test. The addition of atropine to AT echocardiography may enhance the sensitivity for detection of coronary artery disease (CAD). The purpose of this study was to determine the utility of AT-atropine echocardiography for detection of CAD. The group studied consisted of 112 patients with suspected CAD. Sixty-one patients did not have a history of prior myocardial infarction (group I) and 51 patients did (group II). AT was infused intravenously at 180 microg/kg/min for 14 minutes. Atropine (0.25 mg intravenously, repeated up to maximum total dose of 1 mg) was administered starting after 8 minutes of AT infusion. Ischemic response was defined as new or worsening wall motion abnormality occurring during the infusion. The sensitivity and specificity for detection of CAD were assessed using the representative echocardiograms during single AT infusion and AT-atropine infusion. Sixty-two patients had CAD. Fifty-eight patients (52%) developed minor side effects that resolved promptly. The rate-pressure product (10(3)/mm Hg beats/min) was significantly increased at 12 minutes of infusion (12.4+/-3.2) compared with that at baseline (9.1+/-2.3) and that at 6 minutes of infusion (9.4+/-2.1). The sensitivity for detection of CAD was 45% for AT echocardiography and 74% for AT-atropine echocardiography. The specificity was 94% for AT echocardiography and 90% for AT-atropine echocardiography. The sensitivity and specificity of AT-atropine echocardiography was 78% and 93%, respectively, in group I, and 70% and 86%, respectively, in group II. In conclusion, AT-atropine stress echocardiography seems to be well tolerated, safe, and useful for detection of CAD.
关于三磷酸腺苷（ATP）负荷超声心动图的研究较少。ATP负荷试验可能比腺苷负荷试验的不良反应更少。在ATP超声心动图中加入阿托品可能会提高检测冠状动脉疾病（CAD）的敏感性。本研究的目的是确定ATP-阿托品超声心动图检测CAD的效用。研究组由112例疑似CAD患者组成。61例患者无既往心肌梗死病史（I组），51例患者有既往心肌梗死病史（II组）。以180微克/千克/分钟的速度静脉输注ATP 14分钟。在输注ATP 8分钟后开始静脉注射阿托品（0.25毫克，最大总剂量可达1毫克）。缺血反应定义为输注过程中出现新的或加重的室壁运动异常。使用单次ATP输注和ATP-阿托品输注期间的代表性超声心动图评估检测CAD的敏感性和特异性。62例患者患有CAD。58例患者（52%）出现轻微副作用，且很快缓解。与基线时（9.1±2.3）和输注6分钟时（9.4±2.1）相比，输注12分钟时心率血压乘积（10³/毫米汞柱·次/分钟）显著升高。ATP超声心动图检测CAD的敏感性为45%，ATP-阿托品超声心动图检测CAD的敏感性为74%。ATP超声心动图的特异性为94%，ATP-阿托品超声心动图的特异性为90%。在I组中，ATP-阿托品超声心动图的敏感性和特异性分别为78%和93%，在II组中分别为70%和86%。总之，ATP-阿托品负荷超声心动图似乎耐受性良好、安全且对检测CAD有用。
