组织追踪技术及多巴酚丁胺负荷试验在冠心病诊断中的应用

Application of tissue tracking and dobutamine stress echoca rdiographic test in diagnosis of coronary artery disease

目的 探讨组织追踪技术及多巴酚丁胺负荷试验对冠心病患者室壁缺血部位检测的准确性和可靠性。方法 对疑为冠心病患者 2 5例全部进行多巴酚丁胺负荷试验 ,同时在静息状态、负荷状态下 ,用组织追踪技术在心尖四腔观、二腔观及心尖长轴观分别记录收缩期二尖瓣瓣环向心尖方向的运动位移(MAD) ,在上述检查后 1周内进行冠状动脉造影 ,然后再根据冠脉造影结果分为两组 :甲组为左冠状动脉前降支狭窄患者 ,乙组为左冠状动脉前降支正常者。结果 两组之间的常规超声心动图及收缩期MAD在静息状态 ,负荷 10 μg·kg- 1·min- 1,2 0 μg·kg- 1·min- 1,3 0 μg·kg- 1·min- 1时的参数差别无显著性意义 (P >0 .0 5)。在 40 μg·kg- 1·min- 1时 ,左心室前壁位置处测得的收缩期MAD ,甲组患者较乙组患者低 ,且差别有显著性意义 (P <0 .0 1) ,而后间隔、侧壁、下壁、后壁及前间隔位置处测得的收缩期MAD两组之间差别无显著性意义 (P >0 .0 5)。甲组患者前壁、前间隔位置处测得的收缩期MAD在 10 μg·kg- 1·min- 1,2 0 μg·kg- 1·min- 1,3 0 μg·kg- 1·min- 1及 40 μg·kg- 1·min- 1分别与静息状态下比较差别无显著性意义 (P >0 .0 5) ,乙组患者从二尖瓣瓣环后间隔、侧壁、前壁、下壁、前间隔、后壁部分的

Objective The combination of tissue trackin g technique and dobutamine stress echocardiographic test were studied to evaluate the ischemic regions in patients with coronary artery disease(CAD). Methods Total 25 patients with suspected CAD underwent the dobutamine stress echocardiography, and the systolic mitral annular displacement (MAD) was determined in rest and stress by tissue tracking technique. Apical four chamber, two chamber and apical long axis views were used to determine the MAD of 6 sites. Coronary arteriography was performed within 1 week after echocardiographic examination. All patients were then divided to two groups according to the result of coronary arteriography, Group A: patients with the stenosis in left anterior descending coronary artery (LAD), Group B: patients with the normal LAD. Results The parameters of echocardiography and the systolic MAD in rest,10 μg·kg -1 ·min -1 , 20 μg·kg -1 ·min -1 , 30 μg·kg -1 ·min -1 were not significantly different between the two groups(P> 0.05 ), but in 40 μg·kg -1 ·min -1 ,the systolic MAD in sites of anterior wall in group A was lower than that in group B(P< 0.01 ). The systolic MAD in sites of other walls was not significantly different between the two groups(P> 0.05 ). Moreover the systolic MAD of group A in sites of anterior wall and anterior septum in stress were not significantly different when compared with those at rest(P> 0.05 ),the systolic MAD in 6 sites in 20 μg·kg -1 ·min -1 ,30 μg·kg -1 ·min -1 ,40 μg·kg -1 ·min -1 in group B was higher than that in rest (P< 0.05 or P< 0.01 ). Conclusions Tissue tracking technique combined with dobutamine stress echocardiography can show timely and acurately the change of the systolic MAD, and it was safe, accurate and reliable for diagnosing coronary artery disease.