负荷超声心动图检测冠心病室壁运动异常及室壁冠脉血供对应关系的研究

The Study of Correlation between Regional Wall Motion Abnormality Detected by Stress Echocardiography and Vascular Distribution

目的 比较多巴酚丁胺负荷超声心动图(DSE)诱发的节段性室壁运动异常(RWMA)与冠状动脉造影结果,研究RWMA与冠脉血供分布的对应关系。方法 对63例临床疑为冠心病的患者进行DSE和冠状动脉造影检查,将左室分为16个节段进行分析,判定RWMA的部位和范围。结果 ①63例患者冠脉造影阳性48例,单支病变38例,双支病变8例,三支病变2例。对38例单支病变中的32例DSE阳性患者进行RWMA与左室壁冠脉血供对应关系分析,提示冠脉的三大主支狭窄各有相应的左室节段发生BWMA,与美国超声心动图协会(ASE)的结论相似,而右冠脉的供血区域较广于ASE提出的供血区域。②63例患者中DSE检测单支、双支及三支的敏感性分别为84.2％,87.5％和100％。检测出左前降支、右冠脉病变的敏感性(82.1％,76.4％)高于左旋支(33.3％),P<0.05。结论 通过分析DSE诱导的RWMA,可无创估测冠脉狭窄的部位、范围及严重程度,DSE是诊断冠心病的一种可靠而敏感的方法。

Objective We compared the results of regional wall motion abnormality (RWMA) induced by dobutamine stress echocardiography(DSE) and coronary angiography (CAG) in order to evaluate the correlation between RWMA and vascular distribution. Methods We examined 63 patients with suspected coronary artery disease(CAD) by DSE and CAG. The left ventricle (LV) was divided into 16 segments for analyzing the location and regions of segments with RWMA. Results (1) CAG was positive in 48 out of 63, including 38 with one - vessel disease, 8 with two - vessel disease and 2 with three - vessel disease. We analyzed 32 patients out of 38 with one - vessel disease DSE was positive , and evaluated correlation between RWMA and vascular distribution. We deduced the relationship of the certain RWMA for an stenosis involving each of the three major coronary arteries , and the region of LV supplied by right artery was larger than that raised by American Society of Echocardiography. (2) The sensitivity for detection 63 with CAD in one , two and three- vessel CAD subgroups were 84.2% , 87.5% and 100% respectitly. The sensitivity in detecting left anterior artery disease and right artery disease (82.1% , 76.4%) exceeded left circumflex disease (33.3%, P < 0.05). Conclusion We can estimate the location and extent of stenosed coronary artery by analyzing RWMA induced by DSE. DSE is a safe and sensitive tool in diagnosing CAD.