实时三维多巴酚丁胺超声心动图负荷试验评估冠心病的临床观察  

Preliminary study of real.time three-dimensional dobutamine stress echocardiography for coronary artery disease assessment

作　　者：徐勇[1] 刘峻松[1] 智光[1] 王晶[1] 欧书林[1] 杨波[1] 周肖[1] 陈光辉[1] 

机构地区：[1]解放军总医院海南分院心血管内科,三亚572000

出　　处：《中华医学杂志》2012年第39期2747-2751,共5页National Medical Journal of China

基　　金：国家自然科学基金（81141020）

摘　　要：目的探讨实时三维多巴酚丁胺超声心动图负荷试验评估冠心病的安全性、有效性和应用价值。方法选取2011年9至11月在解放军总医院心内科住院临床初诊为冠心病的患者14例，进行实时三维多巴酚丁胺超声心动图负荷试验，多巴酚丁胺以5μg·kg^-1·min^-1为初始剂量，间隔3min依次增加剂量至10μg·kg^-1·min^-1和峰值剂量20μg·kg^-1·min^-1，于静息状态、各剂量负荷阶段和试验结束后3min时采集全容积实时三维超声图像，应用室壁运动计分指数（WMSI）和节段射血分数（rEF）和对各阶段图像分析，两种方法评估结果与冠脉造影术（CAG）进行对比和统计学分析，试验中观察不良反应。结果所有研究对象均顺利完成负荷试验。WMSI和节段EF评估冠心病病变血管结果和冠脉造影术结果比较差异无统计学意义（P〉0．05），两种方法和CAG有满意的一致性（κ系数分别为0．704和0．759），两种方法诊断参数结果：敏感性78％比89％，特异性92％比88％，阳性预测价值（PPV）88％比84％，阴性预测价值（NPV）85％比91％，诊断准确率86％比88％。结论初步研究表明实时三维多巴酚丁胺超声心动负荷试验是一种快捷，安全、有效的评估冠心病冠脉病变的检查方法，具有重要临床意义，值得推广。Objective To evaluate the efficacy and safety of real-time three-dimensional dobutamine stress echocardiography for coronary artery disease assessment. Methods A total of 14 patients suspected of coronary artery disease （CAD） underwent real-time three-dimensional dobutamine stress echocardiography. The initial infusion rate of dobutamine was 5 μg·kg^-1·min^-1, followed by 10 μg·kg^-1·min^-1 and peak infusion 20μg·kg^-1·min^-1 in 3 min stages. At baseline state, stress stages and after the study, the real-time three-dimensional （RT3D） images were captured and assessed by wall motion score index （WMSI） and regional ejection fraction （rEF）. And the parameters of these two modalities versus coronary angiography （CAG） were compared and analyzed. Adverse reactions were also observed. Results All patients completed the stress study uneventfully. As compared with CAG, these two modalities showed no significant difference （ P 〉 0. 05 ） and satisfactory agreement （ κ values of 0. 704 and 0.759 respectively）.The diagnostic parameters of these modalities were： sensitivity （78% vs 89%）, specificity （92% vs 88% ）, positive predictive value （PPV） （88% vs 84% ）, negative predictive value （NPV） （85% vs 91% ） and overall accuracy （86% vs 88% ）. Conclusion Real-time three-dimensional dobutamine stress echocardiography is an effective, rapid and safe technique of assessing coronary artery disease. It is worthy of wider clinical applications.

关 键 词：超声心动描记术 三维 多巴酚丁胺 冠状动脉疾病 

分 类 号：R541.4[医药卫生—心血管疾病]