Manrique A, Derumeaux G, Koning R, Eltchaninoff H, Cribier A, Letac B
Service de cardiologie, CHU de Rouen, Hôpital Charles, Nicolle.
Arch Mal Coeur Vaiss. 1998 Sep;91(9):1111-7.
The aim of this study was to assess the value of low dose dobutamine (5 and 10 gammas/Kg/min) echocardiography for the detection of hibernating myocardium in an infarcted zone three weeks after the initial infarction. The authors studied 23 patients (18 men, 15 women) with an average age of 59 +/- 8 years before and 3 months after angioplasty of the culprit artery. Segmental wall motion was assessed semi-quantitatively by the criteria of the American Society of Echocardiography. All patients had regional contractile abnormalities under basal conditions and all underwent control coronary angiography at 3 months. Improvement of segmental wall motion with dobutamine predicted improvement after revascularisation with positive and negative predictive values of 95% and 85% respectively. The sensitivity and specificity of the test calculated in the usual manner were 83% and 96% respectively. In addition, assessment of diastolic function showed reduction of the isovolumic relaxation time with dobutamine only in patients with hibernating myocardium (120 +/- 30 ms decreasing to 114 +/- 29 ms with dobutamine, p < 0.02). Low dose dobutamine echocardiography therefore allows reliable non-invasive prediction of hibernating myocardium three weeks after infarction. The reduction of isovolumic relaxation time with dobutamine could be an additional argument in favour of the diagnosis.
本研究的目的是评估低剂量多巴酚丁胺（5和10微克/千克/分钟）超声心动图在初次心肌梗死后三周检测梗死区域冬眠心肌的价值。作者研究了23例患者（18例男性，5例女性），平均年龄59±8岁，在罪犯血管血管成形术前和术后3个月进行观察。节段性室壁运动采用美国超声心动图学会的标准进行半定量评估。所有患者在基础状态下均有节段性收缩异常，且均在3个月时接受了对照冠状动脉造影。多巴酚丁胺使节段性室壁运动改善可预测血运重建后的改善，阳性预测值和阴性预测值分别为95%和85%。以常规方式计算的该检查的敏感性和特异性分别为83%和96%。此外，舒张功能评估显示，仅在冬眠心肌患者中，多巴酚丁胺可使等容舒张时间缩短（等容舒张时间从120±30毫秒降至多巴酚丁胺给药后的114±29毫秒，p<0.02）。因此，低剂量多巴酚丁胺超声心动图能够可靠地无创预测心肌梗死后三周的冬眠心肌。多巴酚丁胺使等容舒张时间缩短可能是支持该诊断的又一依据。
