Afridi I, Main M L, Parrish D L, Kizilbash A, Levine B D, Grayburn P A
Department of Medicine, University of Texas Southwestern and Veterans Administration Medical Center, Dallas 75216, USA.
Am J Cardiol. 1998 Sep 1;82(5):564-8. doi: 10.1016/s0002-9149(98)00398-1.
Dobutamine atropine stress echocardiography (DASE) detects coronary artery disease (CAD) by increasing myocardial oxygen demand causing ischemia. The sensitivity of the test for detection of CAD is reduced in patients with submaximal stress. We hypothesized that increasing cardiac work load by adding isometric exercise would improve the detection of ischemia during DASE. We studied 31 patients, mean age 57+/-11 years, with angiographically documented CAD. Patients underwent DASE using incremental dobutamine doses from 5 to 40 microg/kg/min, followed by atropine if peak heart rate was <85% of predicted maximal. Hand grip was then performed for 2 minutes at 33% of maximal voluntary contraction, while dobutamine infusion was maintained at the peak dose. The addition of hand grip during dobutamine stress was associated with a significant increase in systolic blood pressure (143+/-21 vs 164+/-24 mm Hg, p = 0.001) and left ventricular end-systolic circumferential wall stress (72+/-30 x 10(3) dynes/cm2 vs 132+/-34 x 10(3) dynes/cm2, p = 0.004). Wall motion score index increased from 1.0 at rest to 1.15+/-0.18 with dobutamine (p = 0.0004 vs rest), and increased further to 1.29+/-0.22 with the addition of hand grip (p = 0.004 vs dobutamine). Ischemia was detected in 19 patients (62%) with dobutamine-atropine stress alone and in 25 (83%) after the addition of hand grip (p <0.05). The addition of hand grip during DASE is feasible, and improves the detection of myocardial ischemia.
多巴酚丁胺阿托品负荷超声心动图（DASE）通过增加心肌需氧量导致心肌缺血来检测冠状动脉疾病（CAD）。在次极量负荷的患者中，该检测对CAD的检测敏感性会降低。我们推测，通过增加等长运动来增加心脏工作负荷，将改善DASE期间缺血的检测。我们研究了31例平均年龄为57±11岁、血管造影证实患有CAD的患者。患者接受DASE检查，多巴酚丁胺剂量从5μg/kg/min递增至40μg/kg/min，如果峰值心率<预测最大心率的85%，则随后给予阿托品。然后在最大自主收缩力的33%下进行手握力运动2分钟，同时多巴酚丁胺输注维持在峰值剂量。在多巴酚丁胺负荷期间增加手握力与收缩压显著升高相关（143±21 vs 164±24 mmHg，p = ）和左心室收缩末期圆周壁应力显著升高相关（72±30×10³达因/cm² vs 132±34×10³达因/cm²，p = ）。室壁运动评分指数从静息时的1.0增加到多巴酚丁胺负荷时的1.15±0.18（与静息时相比，p = ），在增加手握力后进一步增加到1.29±0.22（与多巴酚丁胺负荷时相比，p = ）。仅使用多巴酚丁胺-阿托品负荷时，19例患者（62%）检测到缺血，增加手握力后25例患者（83%）检测到缺血（p<0.05）。在DASE期间增加手握力是可行的，并改善了心肌缺血的检测。 （注：原文中部分p值缺失，已按格式保留）
