多巴酚丁胺负荷试验ST—T改变诊断冠心病的临床意义

为评估多巴酚丁胺负荷试验ＳＴ－Ｔ改变诊断冠心病的临床意义。对１００例心脏病虱行多巴酚丁胺负荷试验。并分别对照静息双核素单光子发射计算机断层（ＳＰＥＣＴ）心肌显像及冠状动脉造影术。结果显示：１００例受检者负荷试验有８１例出现ＳＴ－Ｔ改变（２０ｍｉｎ内有ＳＴ段压低〉１ｍｍ）合并Ｔ波倒置３８例,Ｊ点后０．０８ｓＳＴ段压低〉１ｍｍ９例,Ｔ波由直立变为倒置２１例、由倒置变为直立１３例,另有严重心律失常６例,     

多巴酚丁胺负荷心电图试验诊断冠心病的临床评价

以冠脉造影为标准,对冠心病组(n=23)和对照组(n=17)作多巴酚丁胺负荷心电图试验,评价该试验对冠心病的诊断价值。阳性的诊断标准为J点后0.08s ST段偏移1mm以上;诊断冠心病的敏感性、特异性、准确度分别为73.9％、76.5％和75.0％。对冠脉单支、双支和三支病变组诊断的敏感性分别为53.8％、100.0％和100.0％。试验中无严重不良反应发生。表明本试验安全可行,诊断冠心病的准确性较好。     

多巴酚丁胺超声心动图负荷试验

多巴酚丁胺超声心动图负荷试验倪超，朱文玲，方圻运动超声心动图（ＥＳＥ）是一种较好的诊断冠心病（ＣＡＤ）的无创性方法［１］，但有部分病人由于种种原因不能运动，因而不能推广。在其他应激试验中，近年来，多巴酚丁胺超声心动图负荷试验（ＤＳＥ）的应用不断增多［...     

多巴酚丁胺负荷诱发下壁心肌梗死Q波导联ST段抬高

男性,42岁,90年因突发心前区压榨样疼痛6小时,在当地医院曾诊为“急性下壁心肌梗死”。96年1月因骑车、快走再次出现心前区疼痛,静息时亦有胸痛,含服硝酸甘油5min内可缓解,发作时心电图示:胸部导联STV2～V4压低0.2～0.3mV,缓解时回到等电位线。因胸痛发作频繁以“陈旧下壁心肌梗死、不稳定型心绞痛”收入院。既往有高血压和糖尿病史及高脂血症,未经系统治疗。有冠心病家族史。查体:血压150/90mmHg(20/12Kpa),脉搏80次/min,心界向左下扩大,心律齐,心尖区可闻及/收缩期杂音。入院后给予抗凝、β-受体阻断剂、降脂、降糖药等处理后病情稳定,…     

多巴酚丁胺负荷心电图试验对冠心病的临床诊断价值

对60例可疑冠心病者进行多巴酚丁胺负荷心电图试验，以冠状动脉造影为标准评价该试验对冠心病的诊断价值。判定标准以J点后0．08秒ST段偏移0．1mV以上为阳性，诊断冠心病的敏感性，特异性、准确度分别为75．7％，78．7％和76．6％。对冠脉单支、双支和三支病变诊断的敏感性分别为52．6％、100％和100％。试验中未发现明显的不良反应，显示本试验是一种安全可行、准确性较好的诊断冠心病的无创检查方法，并可在基层医院推广应用。     

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。     

多巴酚丁胺心电图试验和心电图运动试验诊断冠心病的对照分析

２７例临床拟诊冠心病（ＣＨＤ）患者在冠状动脉造影前同期作多巴酚丁胺心电图试验（ＤＥＴ）和心电图平板运动试验（ＴＥＴ）。两种试验的敏感度、特异度和准确度分别为８６％与８６％，７７％与８５％，８２％与８５％，符合率为８１％。统计学处理结果证明两种方法诊断ＣＨＤ效果相同。１１例同为阳性患者的心电图中，ＳＴ段改变的形式、程度及导联基本相同。研究表明，对因各种原因不能作ＴＥＴ的患者，可用ＤＥＴ替代。     

多巴酚丁胺负荷超声对冠心病的诊断价值探讨

及早检出冠心病，有助于显著改善患者预后。为探讨临床诊断冠心病的理想方法，笔者选择经冠状动脉造影证实的冠心病患者和非冠心病患者，进行多巴酚丁胺负荷超声心动图试验（ＤＥＴ）和运动心电图试验（ＥＥＴ）比较研究，旨在评价ＤＥＴ对冠心病的诊断价值。１对象与方法...     

冠脉血流重建前后ST-T改变的观察

目的探讨冠心病者冠脉血流重建前后心电图ST-T改变规律,为心电图诊断提供依据。方法对接受过冠脉旁道移植术（CABG）或冠脉支架植入术（PTCA）者154例手术前、后ST-T变化进行对比分析。结果手术前静息心电图呈持续性ST-T改变者83例（A组）、易变性ST-T改变者33例（B组）、静息心电图正常但心绞痛或运动试验诱发ST-T改变者35例（C组）、ST-T完全正常者3例（D组）。4组患者手术后观察心电图6月～3年,原有的ST-T情况维持不变者分别为76例（91.6%）、28例（84.8%）、6例（17.1%）、3例（100%）。在异常ST-T维持不变者（110例）中合并陈旧性心肌梗死者17例（15.4%）、高血压者48例（43.6%）、糖尿病17例（15.5%）、风心病2例（1.8%）、其它24例（21.8%）。结论 A组和B组多为高血压、陈旧性心肌梗死、糖尿病和自主神经功能不平衡所致,部分为非特异性ST-T改变,冠脉血流重建对其影响很小;C组多为心肌缺血所致,冠脉血流重建可以使其恢复正常。心电图持续性和易变性ST-T改变不宜诊断为心肌缺血或慢性冠脉供血不足,尤其对冠脉血流重建后的患者。     

Extent and severity of test positivity during dobutamine stress echocardiography. Influence on the predictive value for coronary artery disease.

AIMS: Recent studies have evaluated the diagnostic accuracy and predictive value of dobutamine echocardiography without considering the additional information implied by the magnitude of induced wall motion abnormalities. We sought to evaluate the positive predictive value of dobutamine echocardiography for coronary artery disease from the extent and severity of the induced wall motion abnormality. In addition, we intended to determine factors associated with false-negative dobutamine echocardiography. METHODS AND RESULTS: Two hundred and eighty-three consecutive patients with suspected coronary artery disease underwent dobutamine echocardiography (up to 40 microg x kg(-1) x min(-1)+atropine up to 1 mg) and coronary angiography. The number of segments and the degree of deterioration were used to describe the extent and severity of induced wall motion abnormality. Analysis of clinical, procedural and echocardiographic variables was performed to determine factors associated with false-negative results. The positive predictive value of dobutamine echocardiography increased from 85% to 90%, 94% and 94% with deterioration of wall motion by one grade in >/=1, >/=2, >/=3 and >/=4 segments, respectively (P<0.05). Deterioration of wall motion by two grades in one segment had a positive predictive value of 96% as compared to 85% for deterioration by only one grade in one segment (P<0.05). Patients with false-negative test results received atropine more frequently (28% vs 13%, odds ration [OR]=3.87, 95% confidence interval [CI]=1.54-9.75, P=0.028) than patients with a correct positive result. However, angina (15 vs 37%, OR=0.26, 95% CI=0.09-0.71, P=0.010), ECG changes during dobutamine stress (15% vs 35%, OR=0.49, 95% CI 0.19-1.25, P=0.014) and high image quality (OR 1.59, 95% CI 1.07-2.37, P=0.015) were less frequent. The sensitivity of dobutamine echocardiography increased from 67% to 71% and 86% (P<0.05) with increasing achieved maximal heart rate (<75%, 75-85% and >85% of maximal heart rate). CONCLUSION: The positive predictive value of dobutamine echocardiography increases significantly as the extent and severity of induced wall motion abnormality increases. Thus, the degree of test positivity should be reported in clinical practice. Despite high pharmacological drug doses, the haemodynamic response may still be insufficient in some patients to induce myocardial ischaemia, resulting in false-negative dobutamine echo tests. To maximize the sensitivity of dobutamine echocardiography, the highest haemodynamic stress level, with a heart rate above 85% of the predicted heart rate, should be reached.     

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)     

Pharmacological stress echocardiography in the diagnosis of coronary artery disease and myocardial ischaemia: a comparison between dobutamine and dipyridamole.

The objective of this study was to relate regional wall motion abnormalities assessed by dobutamine and dipyridamole stress echocardiography to quantitative measurements of coronary artery stenoses in consecutive patients referred for coronary angiography, and to compare haemodynamic effects of and complications related to the two agents. Patients underwent stress echoes on separate days in random sequence and had coronary angiography within 3 days of stress echocardiography. Echocardiograms were assessed by two investigators unaware of the patients' coronary anatomy. Coronary angiograms were also assessed quantitatively using the computer-assisted Cardiovascular Angiography Analysis System. There were 46 consecutive patients referred for coronary angiography; 28 were using beta-antagonists. Main outcome measures were sensitivity and specificity for dobutamine and dipyridamole stress echocardiography for detection of coronary artery disease (wall motion abnormalities at rest or stress) and myocardial ischaemia (stress induced new wall motion abnormalities). Sensitivity for the detection of myocardial ischaemia was found to be 57% for dobutamine and 64% for dipyridamole. Specificities were 78% and 89% respectively. Sensitivities for detection of coronary artery disease (lesion > or = 50% diameter stenosis) was 79% for dobutamine and 82% for dipyridamole; specificities were 78% and 89% respectively. These differences between the two agents are not significant. There were no severe side effects with either agent. Mean heart rate rose significantly with both tests but was higher with dobutamine; mean systolic blood pressure rose with dobutamine and fell with dipyridamole. It was concluded that dobutamine and dipyridamole stress echocardiography have similar sensitivities and specificities for detection of myocardial ischaemia and coronary artery disease although the haemodynamic effects of the two agents are different. Both are free from serious complications.     

Role of contrast-enhanced dobutamine stress echocardiography in predicting outcome in patients with known or suspected coronary artery disease

Although the application of intravenous contrast agents during stress echocardiography has been shown to improve diagnostic accuracy for detecting coronary artery disease, less information exists regarding its prognostic value. The aim of this study was to determine the role of contrast-enhanced dobutamine stress echocardiography (DSE) for predicting future cardiac events in patients with coronary artery disease (CAD). We studied 893 patients (mean age: 66, 581 men) with known or suspected CAD undergoing contrast-enhanced DSE. Positivity was defined as new/worsened wall motion abnormality or fixed abnormality during stress. All patients were followed for 15 +/- 10 months to evaluate hard cardiac events (cardiac death and nonfatal myocardial infarction) and total cardiac events (hard cardiac events, congestive heart failure, unstable angina, and late revascularization). Three patients were lost to follow-up, and 128 patients developed cardiac events, including 21 hard cardiac events. The 3-year event free survival rate was significantly lower in patients with positive DSE results than in those with negative DSE results. Stepwise Cox multivariate analysis revealed that positivity of DSE (P < 0.0001, Hazard ratio (HR): 2.48) and peak wall motion score index (WMSI) >1.5 (P < 0.0001, HR: 2.41) were independent predictors for total cardiac events. Considering hard cardiac events, the independent predictors were peak WMSI > 1.5 (P < 0.0001, HR: 6.65) and age > 70 years (P < 0.005, HR: 3.27). We conclude that contrast-enhanced DSE provides important prognostic information for future cardiac events.     

Creatine kinase isoenzyme BB in the cerebrospinal fluid of patients with acute neurological diseases

In order to predict the outcome of patients with acute neurological symptoms at discharge, the concentration of creatine kinase isoenzyme BB (CK-BB) was determined by radioimmunoassay in the cerebrospinal fluid (CSF) of 115 consecutive patients. On admission and over the next 3 days the concentration of CK-BB was significantly increased in patients with brain death and other neurological sequelae compared with those with favourable outcome. There was a variation in time in concentrations of CK-BB between diseases causing neurological sequelae. Thus, cerebrovascular haemorrhages caused highest concentrations on admission, but cerebral ischaemia due to cardiac arrest caused highest concentrations 3 days after admission. On admission the CK-BB measurements were highly specific with high predictive value of positive result when distinguishing patients with brain death and other neurological sequelae from those without complications at discharge. However, when distinguishing patients with brain death from those with other neurological sequelae, the test was most specific and had highest predictive value of a positive result 3 days after admission.     

Accelerated dobutamine stress testing: safety and feasibility in patients with known or suspected coronary artery disease

BACKGROUND: Dobutamine pharmodynamics require approximately 10 min to reach steady state. Despite this, standard dobutamine stress echo typically uses 3-min stages of advancing dobutamine doses because of safety concerns. HYPOTHESIS: In patients with a high pretest probability of coronary artery disease (CAD), a continuous infusion of high-dose dobutamine is a feasible and safe method for performing a dobutamine stress test. METHODS: Forty-seven consecutive patients (mean age 64 +/- 11 years) with 3.0 +/- 1.4 cardiac risk factors underwent dobutamine stress testing utilizing a single, high-dose (40 mcg/kg/min), continuous dobutamine infusion. The 40 mcg/kg/min infusion was continued for up to 10 min or until a test endpoint had been reached. If a test endpoint was not achieved, atropine (up to 1.0 mg) was added. RESULTS: Heart rate rose from 71 +/- 12 to 137 +/- 18 beats/min at peak (p<0.0001) with a concomitant change in systolic blood pressure (143 +/- 35 vs. 167 +/- 38 mmHg; p = 0.001) but no change in diastolic blood pressure (74 +/- 19 vs. 75 +/- 18 mmHg; p = NS). Target heart rate was achieved in 20 of 47 (43%) patients with accelerated dobutamine alone and in 34 of 47 (72%) with the addition of atropine. An average of 11.6 +/- 3.7 min was required to obtain target heart rate. Subjective sensations from the dobutamine occurred in 49% of patients (palpitations 21%, nausea 6%, chest pain 6%, headache 6%, dizziness 13%), mild arrhythmia in 48% of patients (ventricular premature beats 38%, supraventricular tachycardia 10%), and one patient had nonsustained ventricular tachycardia. CONCLUSION: A single, high-dose (40 mcg/kg/min) dobutamine-atropine protocol provides an efficient means of performing dobutamine stress echocardiography with a similar symptom profile as conventional dobutamine infusion protocols in patients with a high pretest probability of CAD. Randomized, controlled studies will be necessary to assess the sensitivity and specificity of this accelerated dobutamine echo protocol.     

运动与多巴酚丁胺负荷99m锝-焦磷酸盐心肌显像诊断冠心病价值的比较

目的　比较多巴酚丁胺和运动99m锝 焦磷酸盐心肌显像诊断冠心病的价值。方法　对12 0例拟诊为冠心病的患者分别进行药物和运动负荷99m锝 焦磷酸盐心肌显像 ,最后经冠状动脉造影确诊为冠心病。结果　多巴酚丁胺负荷诊断冠心病的敏感性为 94 .3 % ,特异性为 88% ,准确性91.7% ,显著高于运动负荷的 75 % ,61%和 68.4 % ,(P <0 .0 1)。结论　多巴酚丁胺对于诊断冠心病具有较高的敏感性和特异性。