三磷酸腺苷和多巴酚丁胺负荷超声造影在冠心病诊断中的对比研究

Adenosine triphosphate versus dobutamine stress contrast echocardiographyin diagnosis of coronary artery disease

目的对比研究三磷酸腺苷和多巴酚丁胺负荷超声造影在冠心病诊断中的应用价值。方法纳入2018年11月至2019年6月就诊于东莞康华医院心血管中心、可疑或确诊冠心病的患者86例,所有患者均行三磷酸腺苷和多巴酚丁胺负荷超声造影连续试验,并进行了冠状动脉造影(CAG)或冠状动脉CT血管造影(CTA)检查。分别以冠状动脉狭窄≥50%、≥75%为冠心病诊断标准,以CAG或CTA结果为对照标准,应用四格表计算三磷酸腺苷和多巴酚丁胺负荷超声造影诊断冠心病的敏感度、特异度和准确性。结果冠状动脉狭窄≥50%为冠心病诊断标准时,以CAG或CTA结果为对照标准,三磷酸腺苷负荷超声造影诊断冠心病的敏感度、特异度、准确性分别为56%、96%、77%;多巴酚丁胺负荷超声造影的诊断敏感度、特异度、准确性分别为76%、96%、86%。多巴酚丁胺负荷超声造影的诊断敏感度和准确性均高于三磷酸腺苷负荷超声造影。冠状动脉狭窄≥75%为冠心病诊断标准时,以CAG或CTA结果为对照标准,三磷酸腺苷负荷超声造影诊断冠心病的敏感度、特异度、准确性分别为81%、97%、94%;多巴酚丁胺负荷超声造影的诊断敏感度、特异度、准确性分别为88%、98%、95%。多巴酚丁胺负荷超声造影的诊断敏感度、特异度和准确性均高于三磷酸腺苷负荷超声造影。结论多巴酚丁胺负荷超声造影诊断冠心病的效能优于三磷酸腺苷负荷超声造影,两者联合应用既增加了检查的安全性又提高了诊断阳性率。

Objective To compare the application value of adenosine triphosphate versus dobutamine stress contrast echocardiography in the diagnosis of coronary heart disease.Methods Eightysix patients with coronary artery disease or suspected coronary artery disease underwent both adenosine triphosphate and dobutamine stress contrast echocardiography,and coronary angiography(CAG)or coronary CT angiography(CTA)was also performed at the Cardiovascular Center of Dongguan Kanghua Hospital from November 2018 to June 2019.Coronary arterial stenosis≥50%and≥75%were used as the diagnostic criteria for coronary artery disease,respectively,and CAG or CTA results were used as the standard for diagnosis.Four-scale table was used to calculate the sensitivity,specificity,and accuracy of adenosine triphosphate and dobutamine stress contrast echocardiography for the diagnosis of coronary heart disease.Results When using coronary arterial stenosis≥50%as the diagnostic standard for coronary heart disease,the sensitivity,specificity,and accuracy of adenosine triphosphate stress contrast echocardiography for the diagnosis of coronary heart disease were 56%,96%,and 77%,respectively;the corresponding percentages of dobutamine stress contrast echocardiography were 76%,96%,and 86%.The sensitivity and accuracy of the latter were higher than those of the former.When using coronary arterial stenosis≥75%as the diagnostic standard for coronary heart disease,the sensitivity,specificity,and accuracy of adenosine triphosphate stress contrast echocardiography for the diagnosis of coronary heart disease were 81%,97%,and 83%,respectively;the corresponding percentages of dobutamine stress contrast echocardiography were 88%,98%,and 95%.The diagnostic sensitivity,specificity,and accuracy of the latter were still higher than those of the former.Conclusion The sensitivity,specificity,and accuracy of dobutamine stress contrast echocardiography for the diagnosis of coronary heart disease are higher than those of adenosine triphosphate stress contrast echocardiography.The former has good diagnostic value for extramural obstructive coronary heart disease,and the latter is suitable for patients with severe coronary artery stenosis.The combination of the two can increases the safety and diagnostic sensitivity.