Comparison of thallium-201 exercise SPECT and dobutamine stress echocardiography for diagnosis of coronary artery disease in patients with left bundle branch block

The present study assessed and compared the diagnostic accuracy of thallium-201 (Tl-201) exercise myocardial single photon emission computerised tomography (SPECT) and dobutamine stress echocardiography (DSE) for detection of coronary artery disease (CAD) in patients with left bundle branch block (LBBB). Study population consisted of 26 consecutive patients with permanent LBBB who were suffering from chest pain. Patients (8 women, 18 men mean age = 57 ± 8 years) were studied with DSE, Tl-201 SPECT and coronary angiography (CAG). Three different approaches for diagnosis of CAD were used to identify CAD in left arterial descending (LAD) coronary artery territories in scintigraphic studies: (1) Approach A (conventional approach): involvement of septal, and/or anterior, and/or apical wall. (2) Approach B: involvement of anterior and septal wall irrespective of apical wall. (3) Approach C: involvement of septum, anterior and apical wall. DSE gave a sensitivity of 91%, specificity of 92% and accuracy of 92% for diagnosis of CAD in the LAD coronary artery territory. Tl-201 SPECT (conventional approach) gave a sensitivity of 100%, specificity of 42% and diagnostic accuracy of 69% for diagnosis of CAD in the LAD coronary artery territory. Sensitivity, specificity and diagnostic accuracy of approach C were 33, 85 and 57% respectively. The specificity of Tl-201 SPECT significantly increased in approach C when compared with approach A and B (p < 0.02). However sensitivity of the Tl-201 SPECT with approach C showed significant decrease when compared with DSE and approach A and B (p < 0.005). Specificity of DSE for diagnosis of CAD in LAD were significantly higher than those of Tl-201 SPECT regarding the approach A and B (p < 0.01). In conclusion the use of DSE for diagnosis of CAD in patients with LBBB seems to be more suitable than Tl-201 SPECT.     

多巴酚丁胺负荷超声心动图结合舒张功能应变率评价冠心病的临床研究

目的探讨多巴酚丁胺负荷超声心动图(DSE)结合应变率显像(SRI)技术中舒张功能参数变化诊断冠心病的临床价值。方法28例临床疑诊为冠心病的患者接受DSE试验并行舒张期SRI参数分析,以冠状动脉造影结果为金标准,比较DSE负荷下二维目测法及SRI检出冠心病患者舒张功能异常的敏感性及特异性。结果狭窄冠状动脉供应心肌节段在峰值剂量(40μg·kg-1·min-1)DSE负荷下与静息状态及小剂量(10~20μg·kg-1·min-1)DSE负荷相比,舒张早期应变率显著降低,舒张开始时间显著延长。DSE检出冠心病患者舒张功能异常的敏感性、特异性、准确率分别为84%、86%及86%,DSE-舒张早期应变率和舒张开始时间检出冠心病患者舒张功能异常的敏感性分别为91%和93%,特异性分别为87%和85%,准确率分别为89%和90%。结论DSE结合SRI中舒张功能参数变化可提高DSE检出冠心病患者舒张功能异常的敏感性,能定量评价冠心病患者DSE状态下的心肌舒张运动状态,具有一定的临床价值。     

小剂量多巴酚丁胺负荷超声心动图试验对可逆性功能障碍心肌预测的新指标

目的：探讨小剂量多巴酚丁胺负荷超声心动图（DSE）试验中左心室功能EF值的变化,即ΔEF这一量化指标预测急性心肌梗死（AMI）后患者的功能障碍心肌是否可逆及其可恢复程度。方法：入选患者25例, 接受小剂量DSE检查,测定负荷试验各阶段的收缩功能EF值,25例患者亦接受冠脉造影,并择期行经皮经腔太动脉成形术（PTCA）治疗,根据病变血管的情况植入支架,在术后3．5－13个月之间复查小剂量DSE试验。结果：以小剂量DSE过程中EF增加值,即ΔEF大于等于15％作为衡量标准,预测可逆性功能障碍心肌的敏感性,特性和准确性分别为70．6％,75％和72％,此预测改善值与无改善值之间的差异有显著性意义（P＜0．05）,结论：ΔEF可以作为准确评价可逆性功能障碍心肌的指标,并且是一种定量测定方法。     

多巴酚丁胺负荷超声评价行经皮经腔冠状动脉成形术及支架植入术后再狭窄

目的 探讨多巴酚丁胺负荷超声心动图(DSE)评价行经皮经腔冠状动脉成形术(PTCA)及支架植入术后再狭窄的临床应用价值.方法 39例行PTCA或支架植入术后1～12个月的患者,在造影前1周内接受DSE检查,多巴酚丁胺剂量递增方案为5、10、20、30、40μg·kg-1·min-15个级别,每级负荷维持3分钟.比较DSE和造影检查结果的一致性.结果 DSE评价PTCA及支架植入术后再狭窄的敏感度为75.0%,特异度为92.6%,准确度为87.2%.结论 DSE评价PTCA及支架植入术后再狭窄具有准确、安全可行的特性.     

仰卧位蹬车运动及多巴酚丁胺负荷超声心动图检测冠心病的对比研究

目的比较仰卧位蹬车运动负荷超声心动图(SBE)和多巴酚丁胺负荷超声心动图(DSE)检测冠心病的价值.方法43例疑为冠心病患者随机在同一时间内进行SBE和DSE检测,先做SBE检查,当心率、血压、心电图检测恢复至静息状态水平再做DSE检查.本组患者经冠状动脉造影证实为冠心病25例,正常者18例.结果SBE和DSE检测冠心病的敏感性、特异性和准确性分别为84.0%vs80.0%、88.9%vs83.3%和86.0%vs76.7%(P>0.05).结论SBE与DSE检测冠心病价值相当,SBE为生理负荷,临床上检测冠心病应首选SBE.     

Which is the better method in detecting significant left anterior descending coronary artery stenosis during contrast-enhanced dobutamine stress echocardiography: coronary flow velocity reserve or wall-motion assessment?

The diagnostic accuracy of dobutamine stress echocardiography (DSE) depends on wall-motion assessment. Coronary flow velocity reserve (CFVR) during DSE can be measured by transthoracic Doppler echocardiography. To investigate comparative diagnostic accuracy between wall-motion and CFVR assessment in the detection of significant left anterior descending coronary artery (LAD) stenosis, 274 patients underwent both contrast-enhanced DSE and coronary angiography. Intravenous contrast agent, Levovist, was injected to enhance left ventricular endocardial border delineation and coronary flow velocity in the LAD. Wall motion was assessed by standard technique, and CFVR was calculated as coronary flow velocity at peak dobutamine stress divided by baseline coronary flow velocity by transthoracic Doppler echocardiography. CFVR could be successfully obtained in 232 patients (feasibility, 85%). After excluding 14 patients with isolated diagonal stenosis, CFVR was significantly lower in 65 patients with significant LAD stenosis than it was in 153 patients without stenosis (1.62 +/- 0.56 vs 2.72 +/- 0.94, P <.001). CFVR < or = 2.0 had a 75% sensitivity, a 81% specificity, and a 79% diagnostic accuracy for detecting significant LAD stenosis, and these values were comparable with those by wall-motion analysis (sensitivity, 78%; specificity, 89%; and diagnostic accuracy, 86%). The measurement of CFVR in the LAD during DSE was feasible and the diagnostic accuracy of CFVR was equivalent to wall-motion assessment in the detection of LAD stenosis.     

Dobutamine stress echocardiography in patients undergoing orthotopic liver transplantation: a pooled analysis of accuracy, perioperative and long term cardiovascular prognosis

Pre-transplant evaluation for orthotopic liver transplantation (OLT) commonly includes a cardiac evaluation using dobutamine stress echocardiography (DSE). We performed a quantitative systematic review assessing DSE’s use in detecting coronary artery disease (CAD) and predicting perioperative and long term cardiac events in patients undergoing OLT. Published studies in pubmed were accessed using keyword searches and bibliographic review. Included studies evaluated the use of DSE in patients undergoing OLT, including its accuracy for detection of CAD, and in predicting perioperative and long term cardiac prognosis for both hard (myocardial infarction, cardiac death, cardiac arrest, and asystole) and soft cardiac events (all other events that were cardiovascular in nature). We calculated DSE’s sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) in the above areas. We identified 7 studies, including a total of 580 patients, which included 4 accuracy studies (n = 110 patients), 4 perioperative studies, and 3 long term studies. Accuracy for CAD included a sensitivity of 0.32, specificity of 0.78, PPV of 0.37, and NPV of 0.75. Accuracy for prediction of perioperative hard and soft cardiac events was a sensitivity of 0.20 and 0, specificity of 0.99 and 0.99, PPV of 0.33 and 0, and NPV of 0.98 and 0.89, respectively. For long term hard and soft cardiac events, sensitivity was 0.5 and 0, specificity 0.99 and 0.98, PPV 0.33 and 0, and NPV 0.99 and 0.96, respectively. DSE has a limited accuracy for the detection of CAD in candidates for OLT. However, among those patients selected for OLT, the negative predictive value of DSE for both perioperative and long term cardiac events is high.     

Noninvasive diagnosis of coronary artery disease in patients with diabetes by dobutamine stress real-time myocardial contrast perfusion imaging

OBJECTIVE: The aim of this study was to assess the accuracy of real-time myocardial contrast perfusion imaging (MCPI) during dobutamine stress in the diagnosis and localization of coronary artery disease (CAD) in patients with diabetes. Myocardial contrast echocardiography is a new technique that allows evaluation of myocardial perfusion. Its utility in diabetic patients has not been defined. RESEARCH DESIGN AND METHODS: Dobutamine-atropine stress test was performed in conjunction with MCPI using Optison or Definity at rest and at peak stress in 128 patients with diabetes and suspected CAD who underwent coronary angiography within 1 month. CAD was defined as > or =50% stenosis in one or more coronary artery. MCPI was considered diagnostic of CAD in the presence of reversible perfusion abnormalities. The normalcy rate of MCPI was additionally determined in 18 asymptomatic nondiabetic patients with low probability. RESULTS: CAD was detected in 101 (79%) patients by angiography. Reversible perfusion abnormalities were detected in 90 patients with and 13 patients without CAD. The overall sensitivity of MCPI was 89% (95% CI 83-95), specificity 52% (33-71), and accuracy 81% (75-88). Reversible abnormalities were detected in two or more vascular distributions in 44 of 56 patients with multivessel CAD and in 8 of 63 patients without (sensitivity 68%, specificity 87%, positive predictive value 84%, and accuracy 79%). Regional sensitivity was 75% (65-85) for left anterior descending CAD, 71% (60-83) for left circumflex, and 67% (55-78) for right CAD. MCPI was normal in 16 of the 18 patients with low clinical probability of CAD (normalcy rate 89%). CONCLUSIONS: MCPI is a useful noninvasive technique for the diagnosis and localization of CAD in diabetic patients. The extent of perfusion abnormalities can identify patients with multivessel CAD with a moderate sensitivity and high specificity.     

彩色室壁运动与声学定量技术评价多巴酚丁胺负荷超声心动图对冠心病的诊断价值

目的：应用智能声学定量（AQi)和彩色室壁运动（CK）技术，对多巴酚丁胺负荷超声心动图（DSE）诱发的冠心病室壁运动异常（WMA）及左室功能改变进行检测，旨在为冠心病早期诊提供更准确的可定量方法。方法：对临床可疑冠心病患者45例，进行AQi-CK-DSE检查，并与冠脉造影结果进行对照。结果：用药后心率、收缩压、心率与收缩压的乘积均明显增高；冠心病病组身血分数、峰值充盈率减少，峰值充盈时间延长。室壁运动计分指数明显增加（P＜0．001）。DSE诊断冠心病的敏感性、特异性、准确性及一致性指标分别为96．5％、93．7％、95．5％及90．3％。阳性、阴性预测值分别为96．5％和93．7％。结论AQi-CD－DSE检测冠心病患者WMA及左心功能的改变，为冠心病病早期诊断提供了一定种安全准确可定量的方法。     

三磷酸腺苷和多巴酚丁胺负荷超声造影在冠心病诊断中的对比研究

目的对比研究三磷酸腺苷和多巴酚丁胺负荷超声造影在冠心病诊断中的应用价值。 方法纳入2018年11月至2019年6月就诊于东莞康华医院心血管中心、可疑或确诊冠心病的患者86例,所有患者均行三磷酸腺苷和多巴酚丁胺负荷超声造影连续试验,并进行了冠状动脉造影（CAG）或冠状动脉CT血管造影（CTA）检查。分别以冠状动脉狭窄≥50%、≥75%为冠心病诊断标准,以CAG或CTA结果为对照标准,应用四格表计算三磷酸腺苷和多巴酚丁胺负荷超声造影诊断冠心病的敏感度、特异度和准确性。 结果冠状动脉狭窄≥50%为冠心病诊断标准时,以CAG或CTA结果为对照标准,三磷酸腺苷负荷超声造影诊断冠心病的敏感度、特异度、准确性分别为56%、96%、77%;多巴酚丁胺负荷超声造影的诊断敏感度、特异度、准确性分别为76%、96%、86%。多巴酚丁胺负荷超声造影的诊断敏感度和准确性均高于三磷酸腺苷负荷超声造影。冠状动脉狭窄≥75%为冠心病诊断标准时,以CAG或CTA结果为对照标准,三磷酸腺苷负荷超声造影诊断冠心病的敏感度、特异度、准确性分别为81%、97%、94%;多巴酚丁胺负荷超声造影的诊断敏感度、特异度、准确性分别为88%、98%、95%。多巴酚丁胺负荷超声造影的诊断敏感度、特异度和准确性均高于三磷酸腺苷负荷超声造影。 结论多巴酚丁胺负荷超声造影诊断冠心病的效能优于三磷酸腺苷负荷超声造影,两者联合应用既增加了检查的安全性又提高了诊断阳性率。     

心肌灌注造影在多巴酚丁胺负荷前后早期诊断冠心病的临床研究

目的探讨心肌灌注造影(MCE)技术在大剂量多巴酚丁胺负荷前后早期诊断冠心病的价值.方法 对临床疑为冠心病患者38例,进行大剂量多巴酚丁胺负荷超声心动图试验,分别在静息状态和多巴酚丁胺负荷超声心动图试验终止时即刻行MCE检查.以冠状动脉造影为金标准将大剂量多巴酚丁胺负荷超声心动图前后心肌灌注状态目测法对冠心病的检出率进行比较.结果 多巴酚丁胺负荷超声心动图检查的38例患者中,9例(24%,9/38)达到峰值负荷水平,22例(58%,22/38)达到中级负荷水平.其中通过冠状动脉造影诊断的27例冠心病患者在多巴酚丁胺负荷前后,通过心肌灌注状态目测法诊断心肌缺血患者的例数分别为10例(37%,10/27)及24例(89%,24/27,χ2=15.565,P＜0.01).结论 大剂量多巴酚丁胺负荷超声心动图结合MCE可提高缺血心肌的检出率,发现隐匿性心肌缺血,为临床无创性诊断早期冠心病患者提供新方法.     

多巴酚丁胺负荷超声造影诊断冠心病的初步研究

目的探讨多巴酚丁胺负荷超声造影（DESC）在冠心病（CAD）诊断中的应用价值。 方法选取2015年11月至2019年6月于东莞康华医院心血管中心行DSEC,并完成了冠状动脉造影（CAG）或冠状动脉CT血管造影（CTA）的患者375例。分别以冠状动脉狭窄≥50%、≥75%为CAD诊断标准,以CAG或CTA结果为对照标准,应用四格表计算DSEC诊断CAD的敏感度、特异度和准确性。 结果冠状动脉狭窄≥50%为CAD诊断标准时,以CAG或CTA结果为对照标准,DSEC诊断CAD的敏感度为43%,特异度为95%,准确性为67%。冠状动脉狭窄≥75%为CAD诊断标准时,以CAG或CTA结果为对照标准,DSEC诊断CAD的敏感度为71%,特异度为96%,准确性为88%,较≥50%时的敏感度、特异度和准确性均有提高。2015年11月至2019年6月行DSEC检查的1300例患者中,因发生不良反应导致检查失败16例,心律失常发生率为25%,其中室性早搏最常见。 结论DSEC对CAD有较好的诊断和指导治疗价值,药物和运动协同负荷是对传统负荷超声造影的改良,方法简易可行,多巴酚丁胺不良反应可防可治。     

彩色室壁动力技术多巴酚丁胺负荷试验在冠心病诊断中的应用

目的⑶探讨彩色室壁动力技术超声心动图对冠心病⒉ Ｃ Ａ Ｄ⒕患者室壁缺血部位检测的准确性和可靠性⒚方法⑶对拟诊或疑为冠心病者及正常人 ４０ 例全部进行 Ｃ Ｋ 超声心动图多巴酚丁胺负荷试验 ⒉ Ｃ Ｋ Ｄ Ｅｃｈ ｏ⒕⒙然后再与冠脉造影结果进行对照⒚结果⑶ Ｃ Ｋ Ｄ Ｅｃｈ ｏ 对于冠脉造影阳性、阴性组患者的诊断预测值分别为 ９１３０％ 、１００％ ⒙总预测值为 ９３９４％ ⒚其诊断 Ｃ Ａ Ｄ 的敏感性、特异性和准确性分别为 １００ ％ 、８３３３％ 和 ９３９４％ ⒚通过对心室壁缺血部位的观察⒙应用 Ｃ Ｋ 技术能够提高心内膜的显示率⒙避免人为因素⒙客观地做出室壁位移的时间值定量⒙明显优于二维超声法⒚结论⑶ Ｃ Ｋ Ｄ Ｅｃｈ ｏ 为 Ｃ Ａ Ｄ 诊断提供了一种安全、可靠的方法⒚     

超声斑点追踪技术结合小剂量多巴酚丁胺负荷试验评价经皮冠状动脉介入治疗效果

目的利用超声斑点追踪成像(STE)技术结合小剂量多巴酚丁胺负荷(DSE)试验预测经皮冠状动脉介入治疗的效果。方法对40例缺血性心脏病患者,于冠状动脉介入治疗(PCI)术前分析其运动异常心肌节段静息与DSE条件下收缩期峰值应变率(SRs)变化。PCI术后9个月复查心脏超声,以室壁运动分数改善作为判断心肌存活的标准。结果 PCI前225个运动异常心肌节段中,术后101个节段室壁运动明显恢复(44.89%),判定为存活心肌,124个节段运动无明显改善(55.11%)。单独应用DSE准确预测72个节段为存活心肌[敏感度71.29%(72/101)],87个节段未恢复心肌[特异度70.16%(87/124)]。STE静息状态下ROC曲线下面积为0.76;SRs截断点-0.49,敏感度71.30%,特异度70.20%;结合DSE后ROC曲线下面积为0.89,SRs截断点-0.75,敏感度89.10%,特异度90.30%。无论静息还是DSE条件下存活心肌SRs均显著大于未恢复心肌(P<0.01)。结论STE与DSE相结合可显著提高预测存活心肌的准确性。潜在的有功能的存活心肌可作为筛选PCI适应证和预测PCI疗效的可靠指标。     

Value of additional myocardial perfusion imaging during dobutamine stress magnetic resonance for the assessment of intermediate coronary artery disease

This study was performed to assess the role of additional myocardial perfusion imaging during high dose dobutamine/atropine stress magnetic resonance (DSMR-wall motion) for the evaluation of patients with intermediate (50?C70%) coronary artery stenosis. Routine DSMR-wall motion was combined with perfusion imaging (DSMR-perfusion) in 174 consecutive patients with chest pain syndromes who were scheduled for a clinically indicated coronary angiography. When defining CAD as the presence of a????50% stenosis, the addition of perfusion imaging improved sensitivity (90 vs. 79%, P?<?0.001) with a non-significant reduction in specificity (85 vs. 90%, P?=?0.13) and an improvement in overall diagnostic accuracy (88 vs. 84%, P?=?0.008). Adding perfusion imaging improved sensitivity in patients with intermediate stenosis (87 vs. 72%, P?=?0.03), but not in patients with severe (??70%) stenosis (93 vs. 84%, P?=?0.06). In patients with severe stenosis specificity of DSMR-perfusion versus DSMR-wall motion decreased (61 vs 70%, P?=?0.001) resulting in a lower overall accuracy (71 vs 74%, P?=?0.03). Using a cutoff of ??50% for the definition of CAD, sensitivity of DSMR-perfusion compared to DSMR-wall motion was significantly higher in patients with single vessel (88 vs. 77%, P?=?0.03) and multi vessel disease (93 vs. 79%, P?=?0.03), whereas no significant differences were found using a cutoff of ??70% stenosis for the definition of CAD. The addition of perfusion imaging during DSMR-wall motion improved the sensitivity in patients with intermediate coronary artery stenosis. Overall diagnostic accuracy increased only when defining CAD as ??50% stenosis. In patients with ??70% stenosis DSMR-wall motion alone had higher accuracy due to more false-positive cases with DSMR-perfusion.     

Dobutamine induced dynamic left ventricular outflow tract obstruction in patients with hypertrophic nonobstructive cardiomyopathy

Some patients with hypertrophic nonobstructive cardiomyopathy (HNCM) suffer symptoms resembling those in obstructive type despite no left ventricular outflow tract (LVOT) gradient could be detected on resting echocardiography. To investigate the value of dobutamine stress echocardiography (DSE) in determining the dynamic left ventricular (LV) obstruction of patients with HNCM. The study was conducted on 31 patients who were diagnosed HNCM on resting echocardiography and 9 healthy person as a control group. Intraventricular flow acceleration of > 3 m/sec on DSE was accepted as dynamic LVOT obstruction. Group 1 and 2 included patients without and with dynamic LVOT obstruction, respectively. The occurrence of chest pain and dyspnea seen during DSE was more frequent in group 2 than group 1 and control group. The frequency of SAM was significantly higher (p < 0.05) and the septal angle was significantly lower (p < 0.001) in Group 2. The presence of SAM significantly correlated with the peak gradient (r = 0.61, p < 0.001). The septal angle had significant negative correlations with the peak gradient (r = -0.77, p < 0.001) reached at DSE. The relative risk for peak gradient was highest when septal angle was < or = 100 degrees, with a sensitivity of 93%, specificity of 80%, positive predictive value of 82%, negative predictive value of 92%, and predictive accuracy of 87%. DSE is a reliable tool for the diagnosis of dynamic LV obstruction in patients with HNCM. The presence of SAM together with a low septal angle is highly predictive for the presence of a dynamic LVOT obstruction detected by DSE.     

Prognostic value of adenosine stress cardiovascular magnetic resonance and dobutamine stress echocardiography in patients with low-risk chest pain

Excluding obstructive coronary artery disease (CAD) as the etiology of acute chest pain in patients without diagnostic electrocardiographic changes or elevated serum cardiac biomarkers is challenging. Stress testing is a valuable risk-stratifying technique reserved for the subset of these patients with low-risk chest pain who have an intermediate clinical probability of obstructive CAD. Given the risks of radiation inherent to nuclear and computed tomography imaging, both adenosine stress cardiovascular magnetic resonance (AS-CMR) imaging and dobutamine stress echocardiography (DSE) are attractive alternative stress modalities. An essential characteristic of stress modalities is their negative prognostic value; as one must exclude clinically-relevant CAD such that patients can be discharged safely. Therefore, the aim of this study was to validate a favorable negative prognostic value for both AS-CMR and DSE in patients presenting with low-risk acute chest pain. This retrospective study included 255 patients with low-risk acute chest pain and no prior history of CAD presenting to the emergency department at our institution, with 89 patients evaluated by AS-CMR and 166 by DSE. Median follow-up was 292?days, and consisted of medical record review. The primary end-point was the composite of cardiac death, nonfatal acute myocardial infarction, obstructive CAD on invasive coronary angiography (ICA) or recurrent chest pain requiring hospital admission. Test characteristics such as sensitivity and specificity could not be evaluated as patients were not routinely evaluated with ICA. All patients completed the stress protocol without adverse events during testing. 82/89 patients (92.1%) and 164/166 patients (98.8%) had negative AS-CMR and DSE studies, respectively. Both AS-CMR and DSE had excellent negative prognostic values for the primary endpoint, 100 and 99%, respectively. Both AS-CMR and DSE are effective stress modalities for excluding clinically significant coronary artery disease in patients presenting acute low-risk chest pain. Patients without findings to suggest ischemia have an excellent intermediate-term prognosis.     

Stress echocardiography in the ED: diagnostic performance in high-risk subgroups

Purpose

To assess stress-echo (SE) diagnostic performance in patients presenting to the emergency department (ED) with spontaneous chest pain, especially in subgroups in which exercise ECG diagnostic performance has been questioned (women, elderly, history of coronary artery disease).

Methods

Between June 2008 and May 2011, 474 patients with an episode of spontaneous chest pain, non-diagnostic electrocardiogram and negative cardiac necrosis markers underwent SE. Patients with inducible ischemia (Isch) were asked to undergo coronary angiography. Patients with negative SE were discharged and contacted by telephone at least 6 months after discharge, to ascertain the occurrence of new cardiac events.

Main findings

Exercise stress-echo (ESE) was employed in 270 patients and dobutamine (DSE) in 218 (including 14 with inconclusive ESE); a diagnosis of coronary artery disease (CAD) was confirmed or excluded in 434 (92%) patients. SE was negative for Isch in 318 patients (206 ESE and 112 DSE) and positive in 132. During follow-up, patients with negative SE had 4 cardiac events. SE showed: sensitivity 90%, specificity 92%, positive predictive value 78% and negative predictive value 97%. Sensitivity was comparable between patients aged < or ≥ 70 years (84 vs 94%) and between gender (89 vs 96%), but lower in patients with known CAD (88 vs 94%, P < .05); specificity was comparable regardless of age (94 vs 99%) and presence of CAD (97 vs 91%), but was lower among women (87 vs 96%, P < .05).

Conclusions

SE had a very good diagnostic performance in ED patients with suspected Isch, both overall and in selected high-risk groups.     

多巴酚丁胺负荷定量组织追踪技术诊断老年冠心病的临床研究

目的探讨多巴酚丁胺负荷超声心动图(DSE)与定量组织追踪技术(TT)相结合诊断老年冠心病的临床价值。方法 98例疑似冠心病老年患者行DSE+TT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峰值位移(Dpeak),2周内行冠状动脉造影后将所有患者分成冠心病组与正常组,并将两组Dpeak进行比较研究。结果冠心病组在10、20μg·kg-1·min-1这两个负荷剂量时前壁、前间隔、侧壁、后壁Dpeak小于正常组,差异有统计学意义(P<0.05),而两组下壁Dpeak在其他任何负荷剂量时差异均无统计学意义(P>0.05);与冠状动脉造影比较,Dpeak诊断老年人冠心病的敏感度、特异度、准确性分别为82.4%、61.7%、72.4%,Dpeak在多巴酚丁胺40μg·kg-1·min-1负荷剂量时其诊断的敏感度和特异度最高,分别为88.2%、69.5%。结论多巴酚丁胺负荷定量组织追踪成像是一项安全、有效、无创诊断老年冠心病的方法。     

背向散射技术结合多巴酚丁胺负荷试验检测不同部位冠状动脉狭窄

目的探讨背向散射技术结合多巴酚丁胺负荷试验(DSE)能否提高对不同部位冠状动脉狭窄的检测率。方法记录32例临床疑诊为冠心病的患者在不同剂量多巴酚丁胺负荷下左室乳头肌水平短轴观的背向散射积分,按冠状动脉造影结果将心肌节段分组,比较各组心肌在各剂量负荷下背向散射积分周期变异(CVIB)值的变化。结果和正常冠状动脉供血心肌节段相比,狭窄冠状动脉供血心肌节段的CVIB值在静息状态和小剂量多巴酚丁胺负荷下无显著差异,但在大剂量负荷下明显降低。以DSECVIB<4.8dB作为检测冠状动脉狭窄的阈值,对于左前降支病变,DSECVIB法可提高敏感性、特异性和准确率;对于左旋支和右冠状动脉病变,DSECVIB法未能提高检测的敏感性,而提高了特异性和准确率。结论背向散射技术与传统DSE联合应用可提高DSE对不同部位冠状动脉狭窄的检测率,尤其对于左前降支的病变。