腺苷负荷超声心动图对稳定性心绞痛患者冠状动脉狭窄程度的评估  

Assessment of Coronary Stenosis Using Adenosine Stress Echocardiography by Tissue Doppler Imaging

作　　者：郑平[1] 王浩[1] 田月琴[2] 何作祥[2] 陆叶[1] 郭远林[3] 郑昕[3] 马文君[4] 徐楠[1] 张凌[2] 

机构地区：[1]北京协和医学院中国医学科学院阜外心血管病医院超声科,北京市100037 [2]北京协和医学院中国医学科学院阜外心血管病医院核医学科,北京市100037 [3]北京协和医学院中国医学科学院阜外心血管病医院冠心病诊治中心,北京市100037 [4]北京协和医学院中国医学科学院阜外心血管病医院高血压病诊治中心,北京市100037

出　　处：《中国循环杂志》2011年第2期97-100,共4页Chinese Circulation Journal

基　　金：国家"十一五"子课题;腺苷课题组课题基金资助项目(NO.2007BAI05B01)

摘　　要：目的：通过腺苷负荷超声心动图评估稳定性心绞痛患者冠状动脉（冠脉）狭窄程度。方法：46例稳定性心绞痛患者在腺苷负荷前、过程中行超声心动图检查，得到二尖瓣前向血流频谱舒张早期快速充盈波（E）和舒张晚期充盈波（A）之比（E／A）、组织多普勒二尖瓣环舒张早期运动速度（E’）和舒张晚期运动速度（A’）之比（E’／A’）以及E／E’；次日行冠脉造影或冠脉计算机断层扫描。按其结果分组：正常组（n=15）；冠脉狭窄50％-70％组（n=15）；冠脉狭窄≥70％组（n=16）。比较组间及组内差异，行受试者工作特征曲线分析。结果：腺苷负荷前各组间各指标差异无统计学意义。腺苷负荷中正常组与冠脉狭窄≥70％组E／E’月％差异有统计学意义（P〈0．05）。腺苷负荷中冠脉狭窄≥70％组E’间隔／A＇间隔、E’侧壁／A’侧壁及冠脉狭窄50％～70％组E’侧壁／A’侧壁较用药前显著降低（P均〈0．05）。腺苷负荷前、过程中正常组和冠脉狭窄≥70％组△E’间隔／A’间隔差异有统计学意义（P〈0．05）。受试者工作曲线显示△E’间隔／A’间隔≥0．037判定无显著冠脉狭窄（即狭窄〈70％）的敏感性67％，特异性94％。结论：腺苷可诱发冠脉狭窄≥70％者左心室舒张功能降低，负荷前及过程中的△E’间隔／A’间隔≥0．037排除冠脉狭窄≥70％的特异性达到94％。Objective：To assess the coronary stenosis in patients with stable angina pectoris （SAP）using adenosine stress echocardiography by tissue Doppler imaging. Methods：A total of 46 patients underwent echocardiography prior and during adenosine administration, we analyzed the parameters of mitral annular early velocity（ E＇ ）and annular late velocity（ A＇ ）at both mitral septal and lateral level, transmitral inflow early velocity（E） and late velocity（A） and E/E＇. Coronary angiography （CAG）or CT examination were performed in the following day,the patients were assigned into three groups by which result as Normal group, n = 15, Coronary stenosis = 50%-70% group,n = 15 and Coronary stenosis ≥70% group, n = 16. The differences inter-and intra-groups were analyzed. Receiver operating characteristic（ROC） curve was used. Results：There was no difference of all parameters among 3 groups before adenosine administration. The E/E＇ in Coronary stenosis≥70% group was higher than that in Normal group during adenosine administration, P 〈 0. 05. E＇ septal/A＇septal and E＇ lateral/A＇ lateral in Coronary stenosis≥70% group and E＇lateral/A＇lateral in Coronary stenosis = 50% - 70% group were decreased during stress compared with the baseline, P 〈 0. 05 respectively. The A E＇ septal/A＇septal had the statistic significance before and during adenosine stress between Normal group and Coronary stenosis ≥ 70% group, P 〈 0. 05. ROC curve presented that when △E＇septal/A＇septal≥0. 037 ,the predicting specificity for coronary stenosis 〈 70% was 94% ,and the sensitivity was 67%. Conclusion：Adenosine may induce left ventricular diastolic dysfunction in patients with coronary stenosis ≥70%. When △E＇ septal/A＇septal ≥0. 037, the predicting specificity for coronary artery stenosis 〈 70% was 94%.

关 键 词：腺苷负荷超声心动图 冠状动脉造影 稳定性心绞痛 舒张功能 

分 类 号：R541.4[医药卫生—心血管疾病]