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

Clinical research on value of dobutamine stress echocardiography combined with variation of diastolic function indexes in strain rate imaging in diagnosis of coronary artery disease

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。

Objective To investigate the clinical value of dobutamine stress echocardiography（DSE） combined with variation of diastolic function indexes of strain rate imaging（SRI） in the diagnosis of coronary artery disease（CAD）. Methods Twenty-eight patients with suspected CAD received DSE and analysis diastolic function indexes in strain rate imaging, before selective coronary angiography（SCA）. Using SCA results as the golden standard of the diagnosis, the diagnostic sensitivity, specificity and accuracy rate of conventional eye-view and DSE-SRI were compared. Results The peak strain rate during early diastolic （SRe） of myocardial segments perfused by stenotic coronary artery were lower and the time of the beginning of diastole（Td） were longer than that of segments perfused by normal coronary artery during high dose DSE. For conventional DSE eye-view method, the diagnosis of sensitivity,specificity and accurary rate were 84%,86% and 86%, while that of DSE-SRe（Td） were 91% （93%）,87% （85%） and 89% （90%）, respectively. Conclusions DSE combined with variation of diastolic function indexes of SRI can improve the noninvasive diagnostic sensitivity of abnormal diastole of CAD, as well as quantitative analysis of the diastolic condition of CAD patients under DSE.