左心室長軸機能によるドブタミンストレス中の非血動性心筋病と非血動性心筋病の区別:左束枝ブロックの追加の効果
Alison M Duncan1, Darrel P Francis, Derek G Gibson
1Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. a.duncan@ic.ac.uk
Circulation
|August 27, 2003
まとめ
ドブタミンストレスエコーカルディオグラフィの期間中の定量化された長軸機能は,拡張性心筋症候群の冠動脈疾患,特に左バンドル・ブランチ・ブロックの検出において,壁運動スコア指数よりも正確です.
科学分野:
- 心臓病学 心臓病学
- エコーカルディオグラフィー エコーカルディオグラフィー
- メディカルイマージング (医学イメージング)
背景:
- 静止壁の運動異常は,不全性心筋病と非不全性心筋病を区別するのに不十分である.
- 壁運動スコア指数 (WMSI) によるドブタミンストレスエコーカルディオグラフィ (DSE) は,拡張性心筋病 (DCM) の冠動脈疾患 (CAD) を特定することができますが,主観的で,左バンドル・ブランチ・ブロック (LBBB) によって挑戦されます.
- 長軸運動はイシュケミアに敏感であり,定量的な評価に適しています.
研究 の 目的:
- 定量的な長軸関数とWMSIの有効性を比較して,LBBBとDCMの患者のCADを検出する.
主な方法:
- 73人のDCM患者 (48人のCAD,25人の無) を研究した.
- 長軸Mモード,パルス波組織ドップラー,およびWMSIは,静止状態とピークドブタミンストレスで評価されました.
- CADの差別因子には,シストリック振幅を2mm,または初期ダイアストリック速度を1.1cm/sで増加させることができなかった.
主要な成果:
- 定量的な長軸関数 (シストリック振幅と延長速度) は,WMSIよりもCADの予測精度が高いことを示しました (85%/86%と71%/94%対67%/76%).
- セプト機能または平均長軸機能の変化は,同様の予測精度を示しました.
- LBBBの患者では,シストリック振幅がCADの唯一の有意な差別因子であり,94%の感度と100%の特異性を達成しました.
結論:
- 定量化されたストレスの長軸関数は,標準のWMSIと比較して,DCMにおけるCADを識別するための優れた感度と特異性を提供します.
- この定量的なアプローチは,WMSIが信頼性が低いLBBBの存在において特に価値があります.
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