CAJ | 학술논문

目的通过与运动负荷超声对照,评估多巴酚丁胺激发超声激发肥厚型心肌病左心室流出道压力阶差(LVOTG)的有效性.方法人选静息LVOTG ＜50 mm Hg(1 mm Hg =0.133 kPa)的肥厚型心肌病患者40例,均进行直立踏车运动和多巴酚丁胺静脉泵入激发,多巴酚丁胺以200μg/min为起始剂量静脉泵入,每间隔5 min增加200 μg/min,最大剂量至1200 μg/min.多普勒超声心动图测定静息、运动峰值和多巴酚丁胺激发过程中的LVOTG.比较两种方法激发的LVOTG和左心室流出道梗阻的发生情况.结果 36例静息LVOTG＜ 30 mm Hg的患者中,17例经运动激发出潜在梗阻,18例经多巴酚丁胺激发出潜在梗阻,两种方法的符合率为91.7％,kappa值为0.833.多巴酚丁胺800 μg/min剂量激发LVOTG与运动峰值LVOTG比较差异无统计学意义(P=0.181),两者的相关性好(r =0.902,P＜0.001).结论多巴酚丁胺激发超声可作为激发肥厚型心肌病患者LVOTG的备选方法 .
목적 통과여운동부하초성대조,평고다파분정알격발초성격발비후형심기병좌심실류출도압력계차(LVOTG)적유효성.방법 인선정식LVOTG ＜50 mm Hg(1 mm Hg =0.133 kPa)적비후형심기병환자40례,균진행직립답차운동화다파분정알정맥빙입격발,다파분정알이200μg/min위기시제량정맥빙입,매간격5 min증가200 μg/min,최대제량지1200 μg/min.다보륵초성심동도측정정식、운동봉치화다파분정알격발과정중적LVOTG.비교량충방법 격발적LVOTG화좌심실류출도경조적발생정황.결과 36례정식LVOTG＜ 30 mm Hg적환자중,17례경운동격발출잠재경조,18례경다파분정알격발출잠재경조,량충방법 적부합솔위91.7％,kappa치위0.833.다파분정알800 μg/min제량격발LVOTG여운동봉치LVOTG비교차이무통계학의의(P=0.181),량자적상관성호(r =0.902,P＜0.001).결론 다파분정알격발초성가작위격발비후형심기병환자LVOTG적비선방법 .
Objective To compare left ventricular outflow tract (LVOT) gradient induced by dobutamine stress echocardiography (DSE) and exercise echocardiography (EE) in patients with hypertrophic cardiomyopathy (HCM).Methods DSE and EE were performed in 40 consecutive patients with HCM and LVOT gradient ＜50 mm Hg( 1mm Hg =0.133 kPa) at rest.Dobutamine was administered intravenously at incremental doses of 200,400,600,800 and 1200 p.g/min at 5 min intervals. LVOT gradients were measured at rest,at peak exercise and during each dose of DSE.Results LVOT gradient at rest was lower than 30 mm Hg in 36 patients and between 30 and 49 mm Hg in 4 patients.Of the 36 patients with LVOT gradient ＜ 30 mm Hg at rest,mechanical LVOT obstruction (latent LVOTO)was evidenced in 17 patients during EE and in 18 patients during DSE and good consistency (91.7％,kappa value 0.833) was found between the two maneuvers.The provoked gradient was similar between DSE at 800 μg/min and EE at peak exercise( P =0.181 ).In the 4 patients with LVOT gradient between 30 and 49 mm Hg[ (38.8 + 2.6)mm Hg],LVOT gradient increased to (85.3 +26.4) mm Hg during EE and (105.0 ±28.0) mm Hg during DES.Conclusions DES and EE are comparable and suitable provoke methods for identifying LVOT obstruction in patients with HCM.