不同多巴酚丁胺超声负荷方法对存活心肌的检出价值

Detection of viable myocardium using different protocols of dobutamine stress echocardiography

目的:探讨小剂量多巴酚丁胺负荷超声心动图(LDDSE)与标准剂量多巴酚丁胺负荷超声心动图(DSE)对存活心肌的检出价值。方法:对14例正常人(CON)和20例冠心病(CAD)患者采用标准的DSE方案(0～40μg?kg·min),分别记录静息状态及不同剂量负荷时左室室壁运动情况,并计算静息状态、小剂量(10μg?kg·min)及峰值剂量(40μg?kg·min)负荷时CAD组室壁运动积分(WMSI)的变化。结果:共观察544个心肌节段,CAD组在LDDSE中运动改善者81个,其中75个节段在DSE中发生双相反应,被视为存活心肌。CAD组WMSI静息(b)、小剂量(l)、大剂量(p)时分别为1.36±0.21(P<0.001),1.17±0.16(P<0.001),1.48±0.20(P<0.05)。结论:DSE对CAD病人存活心肌的无创性诊断具有应用价值,LDDSE检测CAD患者存活心肌具有较高的敏感性,但特异性低于DSE双相反应方法。

Objective:To investigate the value of low dose dobutamine stress echocardiography (LDDSE)and standard dobutamine stress echocardiography (DSE)in detecting viable myocardium of CAD patients.Methods:Standard DSE protocol were performed in14healthy persons and20CAD patients who had been admitted for a quantitative coronary angiography(QCA).The changes of left ventricular wall motion were recorded during dobutamine(Dob)infusion and the wall motion were graded and marked in a semi-quantitative motion using the standard16-segment 4-score model in each segment at baseline,10μg?kg·min and40μg?kg·min during Dob infusion.Results:Altogether544segments,81Segments'wall motion improved during LDDSE,75segments had a biphasic response in CAD.WMSI of CAD at baseline(b)was1.36±0.21(P<0.001),at low dose(l)was1.17±0.16(P<0.001),at peak dose(p)was1.48±0.20(P<0.05).Conclusions:DSE is a valuable noninvasive method in detecting viable myocardium of CAD patients.LDDSE has a high sensitivity in detecting viable myocardium,but it has a lower specificity than DSE method.