多巴酚丁胺负荷应变成像技术诊断老年冠心病的研究

Study on Dobutamine Stress Strain Imaging for the Diagnosis of Senile Coronary Artery Disease

目的探讨多巴酚丁胺负荷超声心动图(DSE)与应变成像技术(SI)相结合诊断老年冠心病(CAD)的临床价值。方法 98名疑似冠心病老年患者行DSE+SI检查,测定不同多巴酚丁胺负荷剂量时各室壁中段收缩期心肌峰值应变(Speak),2周内完成冠状动脉造影(CAG)检查,根据CAG检查结果分为冠心病组和正常组。结果冠心病组各心肌节段Speak在多巴酚丁胺10、20μg.kg-1.min-1负荷剂量时小于正常组,差异有统计学意义(P<0.05或P<0.01),而在40μg.kg-1.min-1时两组之间无统计学差异(P>0.05);和CAG相比,Speak诊断老年人CAD的敏感性、特异性、精确性分别为78.6%、72.3%、74.7%;Speak在不同多巴酚丁胺负荷剂量时诊断的敏感性和特异性不同,在20μg.kg-1.min-1负荷剂量时最高,分别为85.4%、67.4%;对于三支冠脉血管的定位诊断均表现为高特异性。不良反应发生率低。结论多巴酚丁胺负荷定量应变成像技术是一项安全、有效、无创诊断老年冠心病的方法。

Objective To explore the clinical value of dobutamine stress echocardiography（DSE）and stress imaging（SI）in the diagnosis of senile coronary artery disease（CAD）.Methods 98 cases of suspended CAD were underwent DSE＋SI.Peak strain（Speak）of mid-segment systolic period of various ventricular walls was detected.The complete coronary angiography（CAG）was performed in 2 weeks.According to the results of CAG,a CAD group and a normal group were divided.Results Speak at each myocardial segment during dobutamine stress by 10 and 20 μg·kg-1·min-1 was less than that in normal group,indicating statistical significant difference（P0.05或P0.01）.However Speak during dobutamine stress in 40 μg·kg-1·min-1 did not present significant difference between two groups（P0.05）.As compared with CAG,the sensitivity,specificity and accuracy of Speak in the diagnosis of senile CAD were 78.6%,72.3% and 74.7% separately.The sensitivity and specificity at each dobutamine dose were various.They were up to the highest,85.4% and 67.4% separately at 20 μg·kg-1·min-1 stress.The topical diagnosis of three coronary vessels presented high specificity.The incidence of adverse reaction was low.Conclusion Dobutamine stress quantitative strain imaging is a safe,effective and non-invasive technique for the diagnosis of senile CAD.