腺苷超声心动图负荷试验诊断冠心病的应用价值

目的：评价腺苷超声心动图负荷试验诊断冠心病的敏感性、特异性和安全性。方法：.60例临床拟诊冠心病（CAD）的患者，分别静脉注射腺苷造成心肌缺血，注射剂量为140μg/kg/min，用药时间6分钟（总剂量0.8mg/kg）。注射过程中观察和记录室壁运动变化，患者症状、血压和心率。左室16节段中出现室壁运动异常（WMA）为阳性。心电图阳性标准是ST段下降0.1mV。试验后一周内行冠脉造影，以三条主要血管至少有一支或主要初发支管径狭窄≥50％为阳性。以冠脉造影为金标准，计算腺苷负荷试验敏感性和特异性等。结果：26例确诊为CAD的患者中腺苷负荷试验阳性24例，腺苷负荷心电图阳性11例。另外34例冠脉造影正常的患者中有6例为腺苷负荷试验阳性。冠脉造影见病变血管45支，正常135支，腺苷负荷试验阳性血管34支（其中28支与冠造相符合），阴笥146支。腺苷超声心动图诊断CAD的敏感性为92. 3%,trf naj ntg o 82.3％及准确度为86.7％。腺苷负荷试验判断血管病变的敏感性为62.2％，特异性94.8％，阳性预测值80.0％，阴性预测值88.3％和准确度为86.7%；诊断AD单支、双支和三支病变的敏感性分别为83.3％，100％和100％。不良反应发生率为73.3%,但症状轻微，患者均能耐受，无严重不良反应发生。结论：腺苷超声心动图负荷试验诊断CAD安全可靠。

The Value of Adenosine Stress Echocardiography in Diagnosis of Coronary Artery Disease

Objective:The aims of the study were to assess the value of adenosine stress echocardiography in diagnosis of CAD and to determine the sensitivity,specificity and accuracy by the golden criterion of coronary angiography.Methods：Adenosine stress echocardiography was performed in 60 suspectable CAD patients using infusion dose of 140μg/kg/min in 6 min.Left ventricular wall motion was recorded during the procedure.Positive criterion was defined as the appearance of wall motion abnormality(WMA).Results:Adenosine stress echocardiography was positive in 24 out of 26 CAD patients and 6 out of 34 normal patients.The total sensitivity of this test was 92.3% and the total specificity was 82.3%.The sensitivity for detection of each coronary artery lesion was 62.2% and the specificity was 94.8%.Furthermore the sensitivity for detection of myocardial ischemia in one,two and three-vessel CAD subgroups were 83.3%，100% and 100% respectively.Side effects due to adenosine infusion were always minimal and well tolerated by the patients and disappeared within seconds after termination of infusion.Conclusions:Adenosine stress echocardiography can be safely performed in suspectable CAD patients with high sensitivity and specificity.