Ikonomidis I, Holmes E, Narbuvold H, Bolstad B, Muan B, Nihoyannopoulos P
Department of Cardiac Sciences, Hammersmith Hospital, London, UK.
Coron Artery Dis. 1998;9(9):567-76. doi: 10.1097/00019501-199809090-00003.
To investigate whether intravenous injection of Infoson facilitates the assessment of left ventricular wall motion and definition of endocardial border and thereby reduces inter- and intra-observer variability during dobutamine stress echocardiography.
Clear detection of the endocardial border is essential during dobutamine stress echocardiography. Although several contrast agents have been tested for their efficacy in enhancing definition of left ventricular endocardium, their usefulness during dobutamine stress echocardiography has not been evaluated.
Thirty coronary artery disease patients underwent dobutamine stress echocardiography. Infoson was injected at 0.2 ml/kg in both apical four- and two-chamber views. Detection of the left ventricular endocardial borders was scored from 0 (undetectable) to 10 (best) and expressed as a percentage of image quality at rest and peak stress by two independent observers. Regional wall motion was also evaluated and the total wall motion score index calculated each time.
Delineation of the left ventricular endocardium improved from 76 +/- 4% to 84 +/- 2% at rest (P < 0.01) and from 75 +/- 4% to 89 +/- 1% at peak stress (P < 0.01) after administration of Infoson. The greatest improvement was seen in the basal and middle regions of the lateral and anterior walls. Inter- and intra-observer variability was reduced after administration of Infoson. At rest, the probability of concordance between two observers increased from 0.86 (0.82-0.89) to 0.91 (0.88-0.94) (P < 0.05) and at peak stress from 0.86 (0.82-0.9) to 0.90 (0.86-0.92) after administration of Infoson (P < 0.05). The probability of concordance between on- and off-line assessment by one observer also increased from 0.84 (0.8-0.88) to 0.90 (0.86-0.93) (P < 0.01) at rest and from 0.90 to 0.92 (NS) at peak stress. Overall, a change in wall motion score index occurred in 16 of 30 (53%) patients after administration of Infoson, thus improving the accuracy of the stress test compared with coronary angiography. The wall motion score index was overestimated in 11 of 16 (37%) patients without Infoson while the detection of new wall motion abnormalities increased in 5 of 16 (17%) (P < 0.01).
Intravenous administration of Infoson facilitates the assessment of wall motion, particularly of the basal lateral and anterior walls where endocardial border drop-out frequently occurs during dobutamine stress echocardiography; it thus reduces the inter- and intra-observer variability.
研究静脉注射英福生（Infoson）是否有助于评估左心室壁运动及确定心内膜边界，从而减少多巴酚丁胺负荷超声心动图检查中观察者间及观察者自身的变异性。
在多巴酚丁胺负荷超声心动图检查中，清晰检测心内膜边界至关重要。尽管已对多种造影剂增强左心室心内膜清晰度的效果进行了测试，但它们在多巴酚丁胺负荷超声心动图检查中的实用性尚未得到评估。
30例冠心病患者接受多巴酚丁胺负荷超声心动图检查。在心尖四腔心和两腔心切面均以0.2 ml/kg的剂量注射英福生。由两名独立观察者对左心室心内膜边界的检测进行评分，从0分（无法检测到）至10分（最佳），并分别表示为静息和负荷峰值时图像质量的百分比。同时评估节段性室壁运动，并每次计算室壁运动积分指数。
注射英福生后，静息时左心室心内膜的清晰显示率从76±4%提高至84±2%（P<0.01），负荷峰值时从75±4%提高至89±1%（P<0.01）。侧壁和前壁基底段及中间段的改善最为明显。注射英福生后，观察者间及观察者自身的变异性均降低。静息时，两名观察者间的一致性概率从0.86（0.82 - 0.89）提高至0.91（0.88 - 0.94）（P<0.05），负荷峰值时从0.86（0.82 - 0.9）提高至0.90（0.86 - 0.92）（P<0.05）。一名观察者在线与离线评估间的一致性概率在静息时也从0.84（可编辑 0.8 - 0.88）提高至0.90（0.86 - 0.93）（P<0.可编辑01），负荷峰值时从0.90提高至0.92（无统计学差异）。总体而言，30例患者中有16例（53%）在注射英福生后室壁运动积分指数发生变化，与冠状动脉造影相比，提高了负荷试验的准确性。在未使用英福生的16例患者中有11例（37%）室壁运动积分指数被高估，而在使用英福生的16例患者中有5例（17%）检测到新的室壁运动异常增加（P<0.01）。
静脉注射英福生有助于室壁运动的评估，尤其是在多巴酚丁胺负荷超声心动图检查中的心内膜边界常消失的基底段侧壁和前壁；因此减少了观察者间及观察者自身的变异性。
