CAJ | 학술논문

目的探讨大剂量多巴酚丁胺负荷试验结合二维应变成像技术早期诊断冠心病的价值.方法对临床可疑的冠心病患者28例进行大剂量多巴酚丁胺负荷试验,分别在静息状态及各级负荷状态下观察室壁运动情况,测定左室各心肌节段心内膜下心肌的纵向收缩期峰值应变,比较大剂量多巴酚丁胺负荷试验目测法及大剂量多巴酚丁胺负荷试验结合二维应变成像技术诊断缺血心肌的敏感性和特异性;计算正常组、冠心病组缺血节段和非缺血节段的纵向收缩期峰值应变平均值并进行组内及组间比较,利用ROC曲线下面积评价纵向收缩期峰值应变预测缺血心肌的敏感性和特异性.结果冠心病组多巴酚丁胺剂量为40μg·kg-1·min-1时目测法检出室壁运动异常6例(共20个节段),通过计算纵向收缩期峰值应变检出缺血心肌15例(共148节段);冠心病组大多数缺血节段纵向收缩期峰值应变较正常组及非缺血节段相同负荷状态明显减低(P＜0.05);大剂量多巴酚丁胺负荷试验目测法和大剂量多巴酚丁胺负荷试验结合二维应变成像技术诊断缺血心肌的敏感性分别为35.3%和88.2%(P＜0.01),特异性分别为100%和100%(P＞0.05)、准确性分别为60.7%和92.8%(P＜0.01).多巴酚丁胺剂量为40μg·kg-1·min-1时以纵向收缩期峰值应变绝对值≤14.9%为截断值,预测缺血心肌节段的敏感性和特异性分别为83.3%和91.7%.结论大剂量多巴酚丁胺负荷试验结合二维应变成像技术可以提高检出缺血心肌的敏感性,定量评价心肌收缩功能的微小改变,发现隐匿性心肌缺血,为临床诊断早期冠心病患者提供了无创性新方法 .
목적 탐토대제량다파분정알부하시험결합이유응변성상기술조기진단관심병적개치.방법 대림상가의적관심병환자28례진행대제량다파분정알부하시험,분별재정식상태급각급부하상태하관찰실벽운동정황,측정좌실각심기절단심내막하심기적종향수축기봉치응변,비교대제량다파분정알부하시험목측법급대제량다파분정알부하시험결합이유응변성상기술진단결혈심기적민감성화특이성;계산정상조、관심병조결혈절단화비결혈절단적종향수축기봉치응변평균치병진행조내급조간비교,이용ROC곡선하면적평개종향수축기봉치응변예측결혈심기적민감성화특이성.결과 관심병조다파분정알제량위40μg·kg-1·min-1시목측법검출실벽운동이상6례(공20개절단),통과계산종향수축기봉치응변검출결혈심기15례(공148절단);관심병조대다수결혈절단종향수축기봉치응변교정상조급비결혈절단상동부하상태명현감저(P＜0.05);대제량다파분정알부하시험목측법화대제량다파분정알부하시험결합이유응변성상기술진단결혈심기적민감성분별위35.3%화88.2%(P＜0.01),특이성분별위100%화100%(P＞0.05)、준학성분별위60.7%화92.8%(P＜0.01).다파분정알제량위40μg·kg-1·min-1시이종향수축기봉치응변절대치≤14.9%위절단치,예측결혈심기절단적민감성화특이성분별위83.3%화91.7%.결론 대제량다파분정알부하시험결합이유응변성상기술가이제고검출결혈심기적민감성,정량평개심기수축공능적미소개변,발현은닉성심기결혈,위림상진단조기관심병환자제공료무창성신방법 .
Objective To investigate the value of high-dose dobutamine stress echocardiography combined with two-dimensional strain imaging in early diagnosis of coronary artery disease. Methods Highdose dobutamine stress echocardiography was performed to 28 patients with suspected coronary artery disease. All wall movements were observed during resting condition and at all stress levels,respectively;the peak systolic longitudinal strain in each endomyocardial segment of left ventricular was measured; the sensitivity and specificity between visual method and two-dimensional strain imaging in diagnosing myocardial ischemia with high-dose dobutamine stress echocardiography were compared. The average peak systolic longitudinal strain was calculated against control group, coronary artery disease group during ischemia segments and non-ischemia segments, and a comparison was made inside each group as well as against the other groups. The area under receiver operating characteristic curve of the peak systolic longitudinal strain was used to predict the sensitivity and the specificity of myocardial ischemia. Results With dobutamine dose of 40 μg·kg-1 · min-1 ,wall motion abnormalities were diagnosed in 6 patients (20 segments) through visual method, myocardial ischemia was found in 15 patients (148 segments) through computing the peak systolic longitudinal strain. Inside the coronary artery disease group during ischemic　segments,the majority of peak systolic longitudinal strain was significantly reduced ( P＜0.05) compared to the non-ischemic segments and the control group. In diagnosing myocardial ischemia in high-dose dobutamine stress echocardiography, the sensitivity of visual method and two-dimensional strain imaging were 35.3％ and 88.2％(P＜0.01), specificity 100％ and 100％(P＞0.05), and accuracy 60.7％ and 92.8％ (P＜0.01). The cutoff value of the peak systolic longitudinal strain was less than or equal to 14.9％, its sensitivity and specificity in predicting myocardial ischemia were 83.3％ and 91.7％,respectively. Conclusions High-dose dobutamine stress echocardiography combined with two-dimensional strain imaging can increase the sensitivity of detecting myocardial ischemia and detect concealed myocardial ischemia. High-dose dobutamine stress echocardiography combined with two-dimensional strain imaging can be used in early diagnosis of coronary artery disease.