多巴酚丁胺负荷组织多普勒诊断老年冠心病的临床价值

目的 探讨多巴酚丁胺负荷超声心动图(DSE)与定量组织多普勒技术(TDI)相结合诊断老年冠心病的临床价值. 方法 98例老年患者行DSE与TDI相结合检查,测定不同多巴酚丁胺负荷剂量时各室壁中段收缩期心肌运动峰值速度(Vpeak)、收缩期心肌峰值位移(Dpeak)、收缩期峰值应变率(SRpeak)、收缩期峰值应变(Speak),2周内完成冠状动脉造影. 结果 和冠状动脉造影相比,Vpeak、Dpeak、SRpeak、Speak诊断老年人冠心病的敏感性、特异性、精确性分别为Vpeak82.4％、61.7％ 、72.4％,Dpeak 82.4％、59.5％、71.4％,SRpeak 71.7％、82.2％、78％,Speak 78.6％、72.3％、74.7％.DSE+ TDI不良反应轻. 结论 DSE与TDI是一项安全、有效、无创诊断老年冠心病的方法,具有较高的敏感性和特异性.     

多巴酚丁胺负荷超声与平板运动心电图诊断冠心病的临床研究

目的评价多巴酚丁胺超声心动图负荷试验(DSE)和平板运动心电图(TET)负荷试验诊断冠心病的价值。方法 46例可疑冠心病患者,行冠状动脉造影(CAG)、DSE及TET检查,以CAG作为诊断冠心病的金标准,比较多巴酚丁胺超声心动图负荷试验及平板运动心电图负荷试验诊断冠心病的准确性。结果多巴酚丁胺超声心动图负荷试验和平板运动心电图负荷试验对冠心病诊断的敏感性是86.2%vs 62.1%(P<0.05),特异性是88.2%vs 76.5%(P>0.05),准确性是87.0%vs 67.4%(P<0.05)。结论多巴酚丁胺超声心动图负荷试验对诊断冠心病有较高的敏感性、特异性和准确性。     

冠心病心肌应变率成像与单光子发射计算机体层显像的临床对照

目的比较心肌应变率成像(SRI)和单光子发射计算机体层显像(SPECT)检测冠心病的优缺点。方法冠心病患者30例,1d内完成冠状动脉造影(CAG)、SRI和SPECT检查,以CAG结果冠状动脉狭窄程度≥70%为标准,判断SRI和SPECT检出心肌缺血的敏感性、特异性和准确性。结果 CAG发现阳性血管共45支,阴性血管共45支。以CAG结果为金指标,SR检出冠心病灵敏度、特异度、准确度分别为83.21%、82.25%、82.77%;SPECT检出冠心病的敏感度、特异度、准确度分别为93.33%、82.22%、87.77%。结论 SRI定量评价局部心肌节段运动,SPECT评价心肌局部血流灌注量;SRI与SPECT检出冠状动脉狭窄准确度较高。这两种方法检测冠状动脉狭窄的准确度差异不显著。     

定量多巴酚丁胺负荷试验评估老年冠心病患者左心功能代偿改变

目的探讨多巴酚丁胺负荷超声心动图(DSE)与多普勒组织超声(TDI)相结合评估老年冠心病患者左心功能代偿变化。方法 2011年1月至2013年12月在北京医院、宣武医院诊治的98例疑似冠心病的老年患者行DSE+TDI检查,测定不同多巴酚丁胺负荷剂量时二尖瓣环平均收缩期峰值速度、舒张早期峰值速度、舒张晚期峰值速度,2周内完成冠状动脉造影(CAG)检查。根据冠状动脉造影结果分为冠心病组和正常组。结果冠心病组有51例患者,正常对照组有47例。在基础状态时,正常组与冠心病组二尖瓣环平均收缩期峰值速度、舒张早期峰值速度、舒张晚期峰值速度无统计学差异。Sa(9.6±1.4比9.7±1.9);Ea(14.2±2.5比14.4±2.9);Aa(9.3±1.7比9.2±1.9)。多巴酚丁胺20μg·kg~(-1)·min~(-1)负荷量时,冠心病患者二尖瓣环平均收缩期峰值速度、舒张早期峰值速度较正常组减低,而舒张晚期峰值速度在多巴酚丁胺40μg·kg~(-1)·min~(-1)时冠心病与正常组仍无统计学差异。结论老年冠心病患者收缩功能及舒张功能的代偿功能均较正常对照组减低,在多巴酚丁胺20μg·kg~(-1)·min~(-1)时能够被敏感地发现。定量多巴胺负荷试验能够反映冠心病老年患者的心脏代偿功能。     

多巴酚丁胺负荷超声心动图试验在心肌梗死冠脉重建术前后判定存活心肌的对比研究

目的:采用多巴酚丁胺负荷超声心动图(DSE)试验评价心肌梗死(MI)病人冠脉重建术(CRV)后心室运动功能恢复的临床意义.方法:选择30例急性心肌梗死病人,在冠脉重建术前、术后6个月,以不同剂量多巴酚丁胺(5、10、15、20、25、30μg·kg-1·min-1)连续静注5min后,用二维超声心动图观察患者室壁运动异常(WMA)节段的变化.结果:在不同剂量多巴酚丁胺下,CRV前后患者的心率、收缩压均呈升高反应(P＜0.05),WMA均有不同程度上的改变(P＜0.05).结论:DSE试验是识别MI区域存活心肌有价值的方法之一.多巴酚丁胺从5μg·kg-1·min-1开始有效,10～15μg·kg-1·min-1达高峰,≥20μg·kg-1·min-1则在术前对部分病人有诱发心肌缺血,使收缩功能恶化及频发室早出现.     

冠状动脉内多普勒技术评价多巴酚丁胺负荷试验对急性冬眠心肌相关冠状动脉血流动力学的影响

目的　观察急性冬眠心肌相关冠状动脉 (冠脉 )血流动力学指标在多巴酚丁胺负荷期间的改变情况及其与急性冬眠心肌的内在联系 ,探讨多巴酚丁胺超声负荷实验 (dobutaminestressechocardiography ,DSE)检查急性冬眠心肌相关冠脉血流动力学的机制。方法　对 1 3只小型中国家猪采用闭胸法建立急性冬眠心肌模型 ,以双相反应作为DSE法检出急性冬眠心肌的阳性标准。采用冠脉内多普勒技术观察DSE期间急性冬眠心肌相关冠脉平均峰值流速 (APV)、舒张收缩流速比值的变化情况 ,并记录DSE期间心率、血压、心率血压二重乘积的变化情况。结果　 (1 ) 1 0只 (77% )家猪成功制备成急性冬眠心肌模型。 (2 )DSE期间急性冬眠心肌相关冠脉APV、舒张收缩流速比值、收缩压、舒张压、心率及心率血压二重乘积均呈上升趋势 ,但使APV出现显著增加的多巴酚丁胺剂量水平(5μg·kg- 1 ·min- 1 )明显低于其他指标出现显著增加的多巴酚丁胺剂量水平 (2 0 μg·kg- 1 ·min- 1 )。 (3)DSE峰值及基础状态APV的变化量与DSE检出的急性冬眠心肌的节段数呈中等程度的正相关 (r =0 66 ,P <0 0 5)。结论　 (1 )DSE期间急性冬眠心肌模型相关冠脉的APV呈上升趋势 ,以舒张期血流增加为主 ,其增加量可能是检测急性冬眠心肌的一个指标。 (2 )DSE检出     

12导联心电图在多巴酚丁胺超声心动图负荷试验中的诊断价值

多巴酚丁胺超声心动图负荷试验(DSE)被广泛用于诊断是否存在冠心病及评价冠心病患者的预后。文章评估了在DSE期间,同时予以12导联心电图检查是否可提高诊断价值。     

多巴酚丁胺负荷超声心动图试验在心肌梗死冠脉重建术前后判定存活心肌的对比研究

目的:采用多巴酚丁胺负荷超声心动图(DSE)试验评价心肌梗死(MI)病人冠脉重建术(CRV)后心室运动功能恢复的临床意义。方法:选择30例急性心肌梗死病人,在冠脉重建术前、术后6个月,以不同剂量多巴酚丁胺(5、10、15、20、25、30μg·kg~(-1)·min~(-1))连续静注5min后,用二维超声心动图观察患者室壁运动异常(WMA)节段的变化。结果:在不同剂量多巴酚丁胺下,CRV前后患者的心率、收缩压均呈升高反应(P<0.05),WMA均有不同程度上的改变(P<0.05)。结论:DSE试验是识别MI区域存活心肌有价值的方法之一。多巴酚丁胺从5μg·kg~(-1)·min~(-1)开始有效,10～15μg·kg~(-1)·min~(-1)达高峰,≥20μg·kg~(-1)·min~(-1)则在术前对部分病人有诱发心肌缺血,使收缩功能恶化及频发室早出现。     

多巴酚丁胺负荷试验QTcd对冠心病的诊断价值

目的探讨多巴酚丁胺负荷试验前、后冠心病与非冠心病患者QTc散离度(QTcd)的变化,评估多巴酚丁胺负荷试验QTcd对冠心病的诊断价值。方法测量选择性冠脉造影证实的30例冠心病与20例非冠心病患者试验前、后QTcd值,并比较分析。结果冠心病组多巴酚丁胺负荷试验终点QTcd明显高于试验前QTcd(P<0.01),非冠心病组无明显差异(P>0.05)。多巴酚丁胺负荷试验终点QTcd≥55ms诊断冠心病的敏感性、特异性、准确性分别为83.3%、85%、84%,QTcd≥10ms(86.7%、85%、86%)高于传统试验ST段压低诊断冠心病的价值(56.7%、50%、54%)(P<0.05)。结论多巴酚丁胺负荷试验QTcd、QTcd可提高冠心病的诊断价值,是一种安全、简便、有效的无创检查方法。     

多巴酚丁胺心电图与超声心动图负荷试验诊断冠心病临床观察

目的评价多巴酚丁胺超声心动图和心电图负荷试验对冠心病的诊断价值。方法选择54例经冠状动脉造影检查的患者,给予多巴酚丁胺心电图负荷试验和超声心动图负荷试验并将其结果与冠状动脉造影结果对比。结果多巴酚丁胺心电图负荷试验诊断冠心病的敏感性为66.67%、特异性72.22%、准确性68.52%,超声心动图负荷试验其敏感为88.8%、特异性50%、准确性75.93%。结论多巴酚丁胺心电图和超声心动图负荷试验对冠心病的诊断分别具有较高的敏感性和特异性,两者结合进行更佳,而且二者与冠脉造影相比费用低,在基层医院是一种安全、有效的无创检查方法。     

Accuracy of dobutamine stress echocardiography in detecting coronary artery disease.

The diagnostic accuracy of dobutamine stress echocardiography (DSE) (incremental infused doses of 5, 10, 20 and 30 micrograms/kg/min) was evaluated in 141 patients who underwent coronary arteriography within 2 weeks of DSE. All patients were being evaluated for known or suspected coronary artery disease (CAD). DSE was interpreted blindly as normal or showing evidence of CAD, depending on the presence of resting or inducible wall motion abnormalities. Coronary arteriograms were reviewed in a blinded, quantitative fashion. DSE had a sensitivity of 96% for detecting patients with CAD, and a specificity of 66%. For the 53 patients with normal resting wall motion, sensitivity was 87% and specificity 91%. The protocol was well-tolerated by all patients. In comparison with wall motion analysis, 12-lead electrocardiograms during dobutamine infusion revealed ischemic changes in only 17% of patients with CAD. It is concluded that DSE is a clinically useful and accurate means for detecting CAD, its specificity is hindered in patients with resting wall motion abnormalities, and it can safely be used in patients with known cardiac disease.     

冠状动脉造影与三种无创性检查诊断冠心病的对比分析

目的评价运动心电图试验（ＥＥＴ）、心肌灌注单光子发射计算机断层显像（ＳＰＥＣＴ）、多巴酚丁胺负荷超声心动图（ＤＳＥ）对冠心病的诊断价值。方法选择６４例冠状动脉造影（ＣＡＧ）检查的患者,并在同期内（间隔＜２周）接受ＥＥＴ、ＳＰＥＣＴ和ＤＳＥ检查。将ＣＡＧ结果分别与ＥＥＴ、ＳＰＥＣＴ和ＤＳＥ结果进行对比分析。结果这三种无创性检查诊断冠心病的敏感性分别为：７７．１％、９４．３％和９１４％;特异性分别为：７２．４％、７５．９％和８９．６％,准确性分别为：７１．９％、８５．９％和９０．６％。结论ＤＳＥ对冠心病的诊断具有较高的敏感性和特异性,且费用较低,是一种安全、有效的检查方法。     

Assessment of coronary artery disease by dobutamine stress echocardiography (DSE)

Background: Dobutamine stress echocardiography (DSE) is a new non-invasive imaging modality which combines two-dimensional echocardiography with cardiovascular stress induced by dobutamine infusion. Its use in patients with suspected or documented coronary artery disease (CAD) is currently under extensive investigation. Aims: To illustrate the clinical utility, safety and diagnostic value of DSE. Methods: One hundred and thirty-seven consecutive patients referred for DSE were studied. Eighty-four patients also underwent coronary angiography. Results: Eleven patients (8%) did not undergo DSE because of poor image quality. Of the remaining 126 patients, 110 (87%) achieved their target heart rate or reached a pre-determined end point during DSE. Eight patients (6%) developed non-cardiac side effects during DSE, none of which required premature termination of the procedure. Cardiac arrhythmias were documented in 15 patients (12%) but only one required intervention. In 84 patients who underwent coronary angiography, DSE showed a sensitivity and specificity of 88% and 83%, respectively, in detecting the presence of, and 75% and 75%o, respectively, in localising significant CAD. In 35 patients who underwent DSE after uncomplicated myocardial infarction, the positive and negative predictive values for cardiac events following infarction in a six-month follow up period were 74% and 62%, respectively. Conclusions: DSE is a well tolerated, safe and useful test in detecting and localising significant CAD. It can also provide useful post-infarctional prognostic information. (Aust NZ J Med 1995; 25: 707-715.) Key words: Echocardiography, dobutamine, coronary artery disease.     

Value of dobutamine stress echocardiography for diagnosis of coronary artery disease in patients with left bundle branch blockage

BACKGROUND: Left bundle branch blockage (LBBB) is a strong predictor of cardiovascular mortality. Non-invasive tests such as exercise-stress testing and scintigraphy studies have no diagnostic value for diagnosis of coronary artery disease (CAD) in patients with LBBB. OBJECTIVE: To study the role of dobutamine stress echocardiography (DSE) in identification of CAD in patients with LBBB. METHODS: Thirty patients (19 men and 11 women, mean age 60 +/- 8 years) with permanent, complete LBBB were studied prospectively with DSE and coronary angiography. RESULTS: Results of DSE were compared with results of coronary angiography for left anterior descending artery and either left circumflex or right coronary artery territories, or both. Significant CAD was found in left anterior descending coronary arteries in 11 patients by coronary angiography; nine of whom were identified by DSE. Significant left circumflex or right coronary artery disease, or both, was found in nine patients; eight of whom were identified by DSE. The sensitivity, specificity and accuracy of DSE for identifying CAD in left anterior descending coronary artery territory were 82, 95 and 90%, respectively. For identifying CAD in the circumflex and right coronary artery territories sensitivity, specificity and accuracy were 88, 96 and 93%, respectively. CONCLUSION: We concluded that DSE is a very sensitive, specific and accurate non-invasive test for identification of CAD, both in left anterior descending and in left circumflex and right coronary artery territories of patients with LBBB.     

负荷超声心动图与负荷单光子发射计算机断层显像评价冠脉介入术后再狭窄（英文）

目的：探讨运用多巴酚丁胺负荷超声心动图（DSE）和硝酸甘油负荷单光子发射计算机断层灌注显像（SPECT）来评价经皮冠状动脉介入（PCI）术后再狭窄的价值。方法：39例PCI术后的患者,在冠状动脉造影前1周内接受DSE和SPECT检查,多巴酚丁胺剂量递增方案为5μg.kg-1.min-1,10μg.kg-1.min-1,20μg.kg-1.min-1,30μg.kg-1.min-1,40μg.kg-1.min-1五个级别,每级负荷维持3min。按照冠脉造影的结果确定DSE,SPECT的敏感性、特异性和准确度,分析比较DSE,SPECT和冠脉造影检查的结果。结果：与冠脉造影相比,SPECT、DSE检查评价PCI术后再狭窄的敏感性（83.3%比75.0%）,准确性（71.8%比87.2%）无显著差异P〉0.05,但与SPECT相比,DSE检查的特异性较高（66.7%比92.6%）,P〈0.05。结论：多巴酚丁胺负荷超声心动图评价经皮冠状动脉介入术后再狭窄准确,且特异性好于SPECT。     

Comparison of squatting stress echocardiography and dobutamine stress echocardiography for the diagnosis of coronary artery disease

Background: Dobutamine stress echocardiography (DSE) is commonly used for the diagnosis for coronary artery disease (CAD). We previously demonstrated that squatting induces wall motion abnormalities (WMA) in areas subtended by stenotic coronary arteries. Objective: This study was designed to test the hypothesis that dobutamine and squatting stress echocardiography are equally useful for the diagnosis of CAD. Methods: We studied 39 patients who were scheduled to have coronary angiography for the evaluation of chest pain. Each patient had squatting stress echocardiography followed by DSE. For squatting stress echocardiography the echocardiogram in standard views was recorded in the standing position. The procedure was repeated during squatting for 2 minutes. Dobutamine echocardiography was performed using standard protocol. The squatting and dobutamine stress echocardiograms were interpreted by an observer blinded to the results of coronary angiography. Results: During squatting, new or worsening WMA developed in 20 patients. Six patients developed WMA in the left anterior descending artery territory, three in circumflex territory, three in the right coronary artery territory, and eight in multiple coronary territories. The sensitivity, specificity, and accuracy of squatting echocardiography for diagnosis of CAD were 95%, 94%, and 94%, respectively. For DSE, the sensitivity, specificity, and accuracy for the diagnosis of CAD were 85%, 94%, and 90%, respectively. There was no significant difference between squatting and dobutamine stress echocardiography for the diagnosis of CAD (P = 0.702). Conclusion: These data indicate that squatting and dobutamine echocardiography are equally useful in the diagnosis of CAD. In selected patients, squatting echocardiography may be used in place of dobutamine echocardiography for the diagnosis of CAD. (Echocardiography 2012;29:695–699)     

Automated analysis of myocardial deformation at dobutamine stress echocardiography: an angiographic validation.

OBJECTIVES: We investigated the accuracy of automated analysis of myocardial deformation during dobutamine stress echocardiography (DSE). BACKGROUND: The time required for segmental measurement of strain rate imaging (SRI) limits its feasibility for quantification of DSE. METHODS: Myocardial deformation was assessed at DSE in 197 patients, 76 with and 61 without coronary artery disease (CAD) at angiography, and 60 at low risk of CAD. Automated deformation analysis was based on velocity gradient and segment length methods of measuring longitudinal motion within a region of interest tracked through the cardiac cycle. Results were compared with independent wall motion scoring (WMS). Patients were randomly divided; group A (n = 69) established optimal cutoffs for the parameters and group B (n = 68) tested their accuracy. RESULTS: The feasibility of WMS exceeded that of both SRI methods at rest and at peak stress. In group A, the area under the receiver-operating characteristics curve of the peak systolic strain rate was 0.90 by both methods, and the optimal cutoffs for detection of CAD were -1.3 (velocity gradient) and -1.2 s(-1) (segment length). The areas under the receiver-operating characteristics curves for end-systolic strain were less (0.87) by both methods, with respective cutoffs of 9% and 8%. In group B, the velocity and segment length methods had respective sensitivities of 87% and 84% for SR, and 87% and 88% for end-systolic strain. Both significantly exceeded that of WMS in the same group (75%). CONCLUSIONS: Automated analysis of myocardial deformation at DSE is feasible and accurate, and may increase the sensitivity of expert conventional reading.     

Comparison of real-time tri-plane and conventional 2D dobutamine stress echocardiography for the assessment of coronary artery disease.

AIMS: Although dobutamine stress echocardiography (DSE) is an accepted tool for the diagnosis of coronary artery disease (CAD), it requires subsequent image acquisitions of the left ventricle (LV) in order to visualize all segments. This makes the procedure relatively time-consuming and might limit its accuracy. With the introduction of matrix array transducers, the real-time simultaneous acquisition of all LV segments has become possible using multi-plane imaging. The purpose of this study was: (i) to test the feasibility and efficiency of real-time tri-plane (RT3P) imaging during DSE, (ii) to compare the accuracy of RT3P DSE in detecting CAD using coronary angiography as the reference method. METHODS AND RESULTS: Thirty-six patients suspected of CAD were prospectively enrolled. Both conventional two-dimensional (2D) and RT3P imaging were performed during a DSE protocol. Coronary angiography was performed within 24 h. Ultrasound data were acquired at each stage of the DSE. The total effective acquisition time for RT3P imaging was significantly shorter (55+/-29 vs. 137+/-63 s, P<0.001). Data yield was similar for both methods (2D: 98% vs. 3D: 97%). Overall sensitivity (93%), specificity (75%), and accuracy (89%) were identical between both methods. On a segmental level, the sensitivity, specificity, and accuracy of the RT3P and the 2D DSE were similar. CONCLUSION: RT3P imaging fastens the DSE protocol without compromising the accuracy for the diagnosis of CAD. This could facilitate a more wide-spread use of DSE and therefore contributes positively to its routine clinical acceptance.     

负荷超声心动图检测冠心病冠状动脉病变部位的临床研究

目的 对比分析冠状动脉疾病(CAD)心绞痛患者多巴酚丁胺负荷超声心动图(DSE)时节段性室壁运动异常(RWMA)与冠状动脉造影(CAG)的结果,以分析和判断其相关的冠脉病变。方法 入选临床诊断或可疑CAD患者38例,静息二维超声心动图(2DE)检查未见RWMA,CAG为单支冠脉病变,并于CAG前1周内进行DSE试验。结果 缺血相关冠脉为左前降支(LAD)时累及前间隔中段,前壁基段、中段和心尖段,后间隔心尖段;缺血相关冠脉为左旋支(LCx)时累及侧壁基段、中段和后壁基段、中段例数居多;缺血相关冠脉为右冠状动脉(RCA)时累及下壁基段和中段例数居多。DSE检测出单支病变中LAD、LCx和RCA的敏感性依次为:78.9％,33.3％和70.0％。在LCx和RCA病变时后壁基段、中段RWMA的发生率比较差异无显著性(P>0.05)。结论 DSE试验对于判断心肌缺血的相关冠脉病变有一定的临床价值。