三磷酸腺苷负荷超声造影在冠状动脉痉挛诊断中的应用

Application of adenosine triphosphate stress contrast-enhanced ultrasound in the diagnosis of coronary artery spasm

目的探讨三磷酸腺苷负荷超声造影在冠状动脉痉挛诊断中的应用。方法收集2019至2020年在东莞康华医院行三磷酸腺苷负荷超声造影及冠状动脉造影,诊断为冠状动脉痉挛的典型病例5例,对其临床特点、冠状动脉造影特点及负荷超声造影检查过程中三磷酸腺苷的剂量用法和出现阳性结果时室壁运动及心肌灌注特点进行总结分析,同时对三磷酸腺苷负荷超声造影在冠状动脉痉挛诊断中的应用经验进行总结。结果5例患者中,4例最大耐受剂量为240μg/(kg·min),1例最大耐受剂量为220μg/(kg·min)。前4例患者在停药后9~11 min出现阳性反应,后1例患者仅停药3 min即出现阳性反应。左心室壁受累节段最多者高达6个(病例1),最少3个(病例2,3)。5例冠状动脉造影结果均为轻度以下狭窄。超声造影与冠状动脉造影一致程度较高的2例,一般的2例,不一致的1例。5例患者均在延迟恢复期方出现冠状动脉痉挛所致的节段运动和灌注异常;心肌灌注和室壁运动异常先于心电图ST-T改变和心绞痛症状发生,5例患者在检查过程中均未出现胸痛症状。结论三磷酸腺苷负荷超声造影用于诊断冠状动脉痉挛性心绞痛,在超声造影条件下能很好观察到心肌运动及心内膜灌注异常,即心肌缺血,早期发现心肌运动异常并及时停药可确保检查安全有效。

Objective To evaluate the value of adenosine triphosphate stress contrast echocardiography in the diagnosis of coronary artery spasm.Methods Five typical cases of coronary artery spasm diagnosed by adenosine triphosphate stress contrast echocardiography and coronary angiography at Dongguan Kanghua Hospital from 2019 to 2020 were collected.The clinical features,the characteristics of coronary angiography,the dose usage of adenosine triphosphate during stress contrast echocardiography,and the characteristics of ventricular wall motion and myocardial perfusion in the presence of positive results were summarized and analyzed.The application of adenosine triphosphate stress contrast echocardiography in the diagnosis of coronary artery spasm was summarized.Results Among the five patients,the maximum tolerated dose was 240μg/(kg·min)in four cases and 220μg/(kg·min)in one.The former four patients showed positive reaction 9~11 min after drug withdrawal,while the latter one showed positive reaction only 3 min after drug withdrawal.The maximum number of the involved segments of the left ventricular wall were six(case 1),and at least three segments were involved(cases 2 and 3).Coronary angiography revealed mild stenosis in all the five cases.The consistency between stress contrast echocardiography and coronary angiography was high in two cases,normal in two,and poor in one.Segmental motion and perfusion abnormalities caused by coronary spasm occurring in all the five patients appeared in the recovery period of stress contrast echocardiography test.Abnormal myocardial perfusion and wall motion preceded electrocardiogram ST-T changes and angina pectoris symptoms.None of the five patients had chest pain during the examination.Conclusion Adenosine triphosphate stress contrast echocardiography can be used to screen patients with variant angina pectoris by inducing coronary spasm. Under the condition of contrast echocardiography, myocardial motion and endocardial perfusionabnormalities can be well observed. As long as the abnormal myocardial motion can be detected early and thedrug can be stopped in time, the safety and effectiveness of the examination can be ensured.