组织多普勒结合腺苷负荷超声心动图试验诊断冠心病的临床研究

Study of tissue Doppler imaging combining with adenosine stress echocardiography in diagnosis of coronary artery disease

目的以冠状动脉造影为金标准,评价组织多普勒结合腺苷负荷超声心动图试验(TDI-ASE)诊断冠心病的敏感度、特异度。方法采用脉冲组织多普勒超声心动图技术(PW-DTI),对48例临床拟诊冠心病的患者分别静脉注射腺苷拟造成心肌缺血,注射剂量为140μg.kg-1.min-1,用药时间6 min(总剂量0.8 mg/kg),分别测量左心室16节段的收缩期室壁运动最大速度和加速度及各节段心肌收缩的达峰时间。同时应用二维腺苷负荷超声心动图(2D-ASE)目测各节段心肌负荷前后的运动异常。结果 30例确诊为冠心病的患者中TDI-ASE阳性24例。18例冠状动脉造影正常的患者中TDI-ASE阳性有3例。应用TDI-ASE诊断冠心病的敏感度为80.0%(24/30),特异度为83.3%(15/18)。而30例确诊为冠心病的患者中2D-ASE阳性22例。18例冠状动脉造影正常的患者中2D-ASE阳性有5例。2D-ASE诊断冠心病的敏感度为73.3%(22/30),特异度为72.2%(13/18)。结论 TDI-ASE安全可行,客观准确诊断冠心病,敏感度及特异度较高。

Objective To assess the value of tissue Doppler imaging by adenosine stress echocardiography（TDI-ASE） in diagnosis of coronary artery disease and to determine the sensitivity and specificity by the golden criterion of coronary angiography.Methods TDI-ASE was performed in 48 patients suspected with coronary artery disease using continuous infusion dose of 140 μg·kg-1·min-1 in 6 mins（total dose of 0.8 μg/kg）.Maximal motion velocities,acceleration velcities and peak time of the 16 segments of systolic left ventricular wall were measured.Meanwhile,two-dimensional echocardiography was used to estimate the grade of ventricular wall segments motion abnormalities before and after stresses subjectively.Results TDI-ASE was positive in 24 of 30 patients with coronary artery disease and 3 of 18 normal persons.The sensitivity of this test was 80.0%（24/30） and the specificity was 83.3%（15/18）.Two-dimensional stress echocardiography（2D-SE） was positive in 22 of 30 patients with coronary artery disease and 5 of 18 normal persons.The sensitivity of this test was 73.3%（22/30） and the specificity was 72.2%（13/18）.Conclusion TDI-ASE has high sensitivity and specificity and could be used as a safe,objective and accurate method for the diagnosis of coronary artery disease.