腺苷负荷超声心动图对不同类型冠状动脉狭窄的诊断价值

目的评价腺苷负荷超声心动图对不同类型冠状动脉狭窄的诊断价值。方法选取拟诊冠心病（CHD）的34例患者，分别进行腺苷负荷超声心动图检查，腺苷注射剂量为140μg·kg^-1·min^-1，用药时间6min（总剂量0.84mg·kg^-1）。注射过程中观察并记录患者的症状、室壁运动变化、血压和心率。左室16节段中部分节段出现室壁运动异常为阳性。腺苷负荷超声心动图检查后1周内行冠状动脉造影，以造影结果为金标准，计算腺苷负荷试验诊断冠心病的敏感性和特异性。结果确诊为CHD的22例患者中腺苷负荷试验阳性20例，余冠状动脉造影阴性的12例患者中腺昔负荷试验阳性4例。冠状动脉造影见病变血管51支，腺苷负荷试验推断病变血管33支。腺苷负荷超声心动图诊断冠心病的敏感性为90.9％，特异性为66.6％；阳性预测值为83.3％，阴性预测值为80％。对单支、双支、3支冠状动脉病变检出的敏感性分别为75.0％、100％、90.9％，阳性率分别为75.0％、71.4％、60.6％。试验过程中患者均能耐受，无严重不良反应发生。结论腺苷负荷超声心动图诊断CHD具有较高的临床应用价值，尤其对于3支血管病变程度不一致的冠状动脉病变患者，可以作为冠状动脉造影前的一种可靠的筛查手段。

The value of adenosine stress echocardiography in diagnosis of different type of coronary artery disease

Objective To assess the diagnostic value of adenosine stress echocardiography testing in patients with coronary heart disease （CAD）. Methods Adenosine stress echocardiography was performed in 34 patients with suspected coronary heart disease （CHD） using infusion dose of 140μg·kg^-1·min^-1 in 6min. Left ventricular wall motion, BP, HR and ECG were recorded during the procedure. Positive criterion was defined as the appearance of wall motion abnormality （WMA）. Using coronary angiography （CAG） as the gold standard the sensitivity, specificity and accuracy were determined. Results Adenosine stress echocardiography was positive in 20 out of 22 CAD patients and 4 out of 12 normal subjects. The total sensitivity of the test was 90.9% and specificity was 66.6%. Furthermore the sensitivity for detection of myocardial ischemia in one, two and three-vessel CAD subgroups were 75%, 100% and 90.9% respectively. The total positivity for detection of numbers of coronary artery lesion was 64.7%. The positivity for detection of numbers of coronary artery lesion in one, two and three-vessel CAD subgroups were 75%, 71.4% and 60.6% respectively. Side effects due to adenosine infusion were minimal and well tolerated by the patients and disappeared within seconds after termination of infusion. Conclusion Adenosine stress echocardiography is a safe and effective method in the diagnosis of CAD.