小剂量多巴酚丁胺及硝酸异山梨酯负荷超声心动图检测左心室收缩功能严重减低患者存活心肌的准确性

Accuracy of low dose dobutamine,isosorbide dinitrate alone and in combination stress echocardiography for identifying viable myocardium in patients with old myocardial infarction and severe left ventricular dysfunction:compared with ^(99m)Tc-MIBI/^(18)FDG

目的与99mTc甲氧基异丁腈(MIBI)/18FDG双核素同时采集法(DISA)SPECT心肌显像对比,评价小剂量多巴酚丁胺、硝酸异山梨酯(异舒吉)单用及合用的二维超声心动图试验检测冠心病左心室收缩功能严重减低患者存活心肌的准确性和安全性。方法40例陈旧性心肌梗死患者,左心室射血分数(39.4±5.1)%,1周内分别完成小剂量多巴酚丁胺、异舒吉单用及合用的二维超声心动图试验和DISASPECT心肌显像。比较两种方法对存活心肌的检出率、符合率和Kappa值。结果对存活心肌的检出率,DISASPECT为64.0%,多巴酚丁胺10μg·kg-1·min-1二维超声为60.1%,异舒吉多巴酚丁胺5μg·kg-1·min-1二维超声为59.1%。以DISASPECT检测结果为标准,药物负荷二维超声识别存活心肌的特异性在85.7%～96.0%,各剂量间差异均无显著性意义(P均>0.05);而识别的敏感性和符合率以多巴酚丁胺10μg·kg-1·min-1二维超声最高,分别为86.5%和86.5%(Kappa=0.71);异舒吉与多巴酚丁胺合用时,敏感性比异舒吉单用、符合率比两者单用时均显著增加(P均<0.001),以异舒吉多巴酚丁胺5μg·kg-1·min-1二维超声最高,分别为84.6%和85.1%(Kappa=0.69),与多巴酚丁胺10μg·kg-1·min-1二维超声相当,且副作用更少。结论检测冠心病左心室收缩功能严重减低患者的存活心肌,多巴酚丁胺10μg·kg-1·min-1二维超声的检出率与DISASPECT心肌显像相当,识别的敏感性和准确性好;异舒吉与小剂量多巴酚丁胺合用,能提高两药单用时的检出率、识别敏感性和准确性,特别是异舒吉多巴酚丁胺5μg·kg-1·min-1二维超声已达多巴酚丁胺10μg·kg-1·min-1单用时水平,且更安全。

Objective To compare the accuracy and safety of low dose dobutamine, Isoket and their combination two dimensional echocardiography(2DE) with ()^(99m) Tc-sestamibi/^(18)F-fluorodeoxyglucose dual isotope simultaneous acquisition(^(99m)Tc-MIBI/^(18)FDG DISA)SPECT myocardial image for identifying viable myocardium in patients with old myocardial infarction(OMI) and severe left ventricular dysfunction. Methods Forty patients with OMI, mean left ventricular ejection fraction ((39.4)±(5.1))%, underwent low dose dobutamine (Dob, 3,5,10 μg·kg^(-1)·min^(-1)), Isoket (270±56)μg/min and their combination (Dob 3,5 μg·kg^(-1)·min^(-1)) 2DE and DISA SPECT within one week. Results The viable segments detecting rate with DISA SPECT was 64%. During the stress 2DE, only the rate with Dob 10 μg·kg^(-1)·min^(-1) and Isoket-Dob 5 μg·kg^(-1)·min^(-1) 2DE were comparable to DISA SPECT, with (60.1)% and (59.1)%, respectively. Compared with the results of DISA SPECT, the specificities of the stress 2DE were (85.7)%(-96.0)%, without significant difference between each dosage (all P>(0.05)). The sensitivity and the agreement rate were best at dose of Dob 10 μg·kg^(-1)·min^(-1) with (86.5)% and (86.5)% (Kappa(0.71)), respectively. When Isoket combined with Dob 3,5 μg·kg^(-1)·min^(-1), the sensitivities and the agreement rates were both significantly improved than either one used (both P<(0.001)), while the sensitivity and agreement rate were both best in Isoket-Dob 5 μg·kg^(-1)·min^(-1) 2DE with (84.6)% and (85.1)% (Kappa(0.69)), respectively, which were equivalent to Dob 10 μg·kg^(-1)·min^(-1) 2DE, and significantly less side effects(P<(0.05)). Conclusions In identifying myocardial viability in patients with OMI and severe left ventricular dysfunction, the viable myocardium detecting rate of low dose Dob 2DE is comparable to DISA SPECT only at dose of Dob 10 μg·kg^(-1)·min^(-1), which also has the best sensitivity and accuracy; while the combination of Isoket and Dob has higher detecting rate, sensitivity and accuracy than either alone. Isoket-Dob 5 μg·kg^(-1)·min^(-1) 2DE is comparable to Dob 10 (μg·kg^(-1)·min^(-1)) 2DE, and even safer.