异舒吉与小剂量多巴酚丁胺超声心动图对冬眠心肌识别的对比研究

Comparison of Isosorbide Dinitrate Echocardiography With Low dose Dobutamine Echocardiography in Identifying Hibernating Myocardium

目的：对比异舒吉和小剂量多巴酚丁胺（Ｄｏｂｕ）二维超声心动图（２ＤＥ）识别冬眠心肌并预测冠状动脉血运重建（ＣＲＶ）术后其功能改善的准确性和安全性。方法：行ＣＲＶ术成功的陈旧性心肌梗死患者２３例，均在术前做异舒吉和小剂量（５和１０μｇｋｇ－１／ｍｉｎ）Ｄｏｂｕ２ＤＥ试验，术后３个月复查２ＤＥ。采用１６－节段半定量分析法将心室壁各节段收缩运动、增厚分级并记分为：１＝收缩正常或增强；２＝轻度减弱；３＝严重减弱；４＝无收缩；５＝收缩呈矛盾运动。用药后≥２个相邻运动异常节段有收缩储备（减少１分或≥２分）定为冬眠心肌，将两试验检出的冬眠心肌与ＣＲＶ术后其收缩功能改善的实际情况对比，计算识别冬眠心肌的敏感性、特异性和准确性。结果：Ｄｏｂｕ５和１０μｇｋｇ－１／ｍｉｎ分别检出了异常运动节段中６８．３％和７２．０％的冬眠心肌节段，而异舒吉试验只检出４９．２％显著为低（Ｐ＜０．０１～０．００１）；Ｄｏｂｕ５和１０μｇｋｇ－１／ｍｉｎ识别冬眠心肌并预测ＣＲＶ术后其功能改善的敏感性、特异性和准确性分别为８２．１％和８６．３％、７８．３％和８０．０％及８１．２％和８４．９％，而异舒吉试验则分别为６０．４％、８３．９％和６６．４％，其?

Objective:To compare the accuracy and safety of Isoket(isosorbide Dinitrate)two dimensional echocardiography(2DE)with low dose dobutamine(Dobu)2DE tests in identifying hibernating myocardium and predicting its functional improvement after coronary revascularization(CRV)in patients with old myocardial infarction(OMI). Methods:Isoket(240—300 μg/min)and low dose(5 and 10 μg·kg -1 /min)Dobu 2DE tests were performed in 23 patients with OMI who scheduled to undergo CRV.CRV including coronary bypass in 6 and coronary angioplasty in 17 was successful,and the follow up 2DE was also done in 3 months after CRV.Using a 16 segment model and semiquantitative analysis method,the left ventricular regional wall motion and thickening in each segment was graded and scored as follows:1=normal or hyperkinesia,2=mild hypokinesia,3=severe hypokinesia,4=akinesia,and 5=dyskinesia.Hibernating myocardium was defined when contractile reserve(1 score or ≥2 scores decreasing)in at least two adjacent abnormal(score 2—5)segments was occurred after Isoket or Dobu.The detected hibernating myocardium segments by the two tests were compared with the actual improvement after CRV to calculate the sensitivity,specificity and accuracy of the two tests in identifying hibernating myocardium. Results:The percentage of hibernating myocardium segments detected from abnormal segments by dobutamine at 5 and 10 μg·kg -1 /min doses was 68 3%(69/101)and 72 0%(67/93),respectively;while that by Isoket was 49 2%(60/122)which was significantly lower than those of Dobu test ( p <0 01 and <0 001).The sensitivity,specificity and accuracy of dobutamine at 5 and 10 μg·kg -1 /min in identifying hibernating myocardium and predicting its functional improvement after CRV were 82 1% and 86.3%,78 3% and 80 0%,and 81 2% and 84 9%,respectively;while those of Isoket were 60 4%,83 9% and 66 4%,respectively which were all significantly lower than those of Dobu test( p <0 001)except specificity.Angina in 2 cases and frequent premature ventricular beats in 1 were induced by dobutamine,while side effects of Isoket were rare and less in severity. Conclusion:Low dose Dobu 2DE is reliable in identifying hibernating myocardium and predicting its functional improvement after CRV,but is likely to induce angina in minority of patients;while Isoket 2DE test is less sensitive,though is safer.