多巴酚丁胺负荷超声心动图诊断冠状动脉再狭窄的研究

STUDY OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY FOR DIAGNOSIS OF RESTENOSIS AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

目的 :评价多巴酚丁胺负荷超声心动图 (DSE)诊断经皮穿刺冠状动脉腔内成形术 (PTCA)后冠状动脉再狭窄的临床价值。方法 :选择 5 0例行PTCA术冠心病患者 ,于PTCA术后 6个月行DSE ,观察试验前后室壁运动 ,并检测和计算左室舒张末期容积指数 (LVEDVI)、左室收缩末期容积指数 (LVESVI)、左室射血分数(LVEF)。室壁运动不变或降低诊断为再狭窄。 1周后行冠状动脉造影 (CAG) ,根据CAG结果分为再狭窄组和非再狭窄组 ,比较两组DSE前后血流动力学变化。结果 :DSE检测冠状动脉再狭窄的敏感性为 81.3% ,特异性为 85 .2 % ,准确性为 84 %。与静息比较 ,再狭窄组LVESVI和LVEDVI明显升高 ,LVEF明显降低 (P <0 .0 5 ) ;与非再狭窄组比较 ,DSE后LVESVI明显升高 ,LVEF明显降低 (P <0 .0 1)。结论 :PTCA术后再狭窄患者DSE试验后心功能明显下降 。

Objective:To evaluate the value of dobutamine stress echocardiography for detecting restenosis after percutaneous transluminal coronary angioplasty(PTCA).Methods:Dobutamine stress echocardiography were done on 50 patients with coronary artery disease 6 months after percutaneous transluminal coronary angiography. An echocardiographic test positive for restenosis was defined as showing wall motion unchanged or decrease induced by dobutamine. Left vemricular end diastolic volume index (LVEDVI), left ventricular end-diastolic volume index (LVESVI) and left ventricular effusion fraction (LVEF) were measured before and after DSE. One week later all patients took coronary arteriography.The subjects were divided into restenosis group and non-restenosis group according to CAG, and hemodynamic chang after DSE were compared.Results:The sensitivity of DSE for the detection of restenosis in arteries with previous PTCA was 81.3%, the specificity 85.2%,and accuracy 84%. In the restenosis group there were increased LVESVI and LVEDVI and decreased LVEF compared with that at resting condition ( P <0.05) There were significant increases on LVESV I and decrease on LVEF in the restenosis group compared with the non-restenosis group after DSE( P <0.01).Conclusions:Our finding indicates that DSE is a useful method for the detection of restenosis after PTCA. Patients with coronary restenosis after PTCA have significant decreased cardic function after DSE.