多巴酚丁胺负荷超声心动图在筛选冠脉临界狭窄病人经皮介入治疗中的价值

Usefulness of Dobutamine Stress Echocardiography(DSE) for the Choice of Percutaneous Coronary Intervention(PCI) in Patients with Coronary Critical Stenosis

目的 探讨多巴酚丁胺负荷超声心动图 (DSE)在选择冠脉临界狭窄病人治疗方案中的作用。方法 选择冠脉造影(Judkin’s法 )证实单支血管 5 0 %± 5 %狭窄男性冠心病病人共 1 0 8例 ,行DSE检测 ,根据室壁运动指数 (WMI)分组。WMI为 1者 ( 31例 )为无缺血组 (A组 ) ,WMI>1者 ( 6 7例 )为缺血组 ,随机将缺血组分为B组 ( 34例 )和C组 ( 33例 )。A组仅给予冠心病一级预防治疗 ,B组和C组均给予系统抗血小板及抗缺血治疗 ,其中B组病人中有 30例行介入治疗。 3个月后重复行DSE检测 ,并记录 3个月间心脏事件的发生情况。结果 DSE诱导心肌缺血的病人行介入治疗后 3个月 (B组 ) ,WMI明显下降 (P <0 0 5 ) ,心脏事件发生率也较低 (P <0 0 5 ) ;DSE无诱导心肌缺血者 (A组 ) ,3个月后WMI仍无异常 ,且无一例发生心脏事件。结论 DSE有可能成为冠脉临界狭窄病人选择介入治疗 (PCI)

Objective To discuss the value of DSE for the choice of PCI treatments in patients with coronary critical narrowing.Methodes DSE was performed after coronary angiography(CAG) to detect myocardial ischemia or hibernating mycardium(HM) for single vessel critical stenosis(50%±5%) in 108 males from 1997 to 2003 Patients were divided into three groups.Group A(n=31) were those without inducible myocardial ischemia [wall movement index(WMI)=1],they weret treated by one class CAD prevention;Group B(n=34) and Group C(n=33) were those who exhibited myocardial ischemia or hibernating myocardium(WMI>1),they were systemically treated with drugs.PCI was only performed in group B(30 cases).DSE was performed again three months later,the heart events were registered during 3 months.Results The WMI were decresed markebly after PCI at 3 month in the patients with inducible myocardial ischemia( P <0 05),the proportions of heart events were lower in group B than in group C( P <0 05);DSE were still negative in group A after 3 months,no one had heart events.Conclusions DSE might act as an effective means to evaluate whether patients with coronary critical stenosis need to be treated by PCI.