通过左心室长轴功能在多布他胺压力期间的缺血和非缺血心肌病的区别:左束-分支块的额外效应
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
概括
在 dobutamine 应力回声心力学过程中量化长轴功能比墙壁运动得分指数更准确,用于检测扩张性心肌病中的冠状动脉疾病,特别是在左捆-分支阻塞的情况下.
科学领域:
- 心脏病学 心脏病学
- 心声回声扫描 (Echocardiography) 是一种心声回声扫描.
- 医疗成像医学成像
背景情况:
- 静止壁运动异常不足以区分缺血性心肌病与非缺血性心肌病.
- 用壁运动得分指数 (WMSI) 进行的多布他胺应激心声学 (DSE) 可以在扩张性心肌病 (DCM) 中识别冠状动脉疾病 (CAD),但是主观的,并受到左束分支阻塞 (LBBB) 的挑战.
- 长轴运动对缺血敏感,可以进行定量评估.
研究的目的:
- 为了比较定量长轴函数与WMSI在检测DCM患者的CAD中的有效性,有或没有LBBB.
主要方法:
- 研究了73名DCM患者 (48名患有CAD,25名没有).
- 长轴M模式,脉冲波组织多普勒和WMSI在静止状态和峰值dobutamine压力时进行了评估.
- 对于CAD的区分因素包括未能将心缩幅增加2毫米或早期心缩速度增加1.1厘米/秒.
主要成果:
- 定量长轴函数 (心缩幅度和延长速度) 对CAD的预测准确度高于WMSI (85%/86%和71%/94%对67%/76%).
- 隔膜或平均长轴功能的变化显示出类似的预测准确性.
- 在LBBB患者中,缩幅度是CAD的唯一显著区分因素,达到94%的灵敏度和100%的特异性.
结论:
- 与标准WMSI相比,量化应力长轴函数为DCM中识别CAD提供了更高的灵敏度和特异性.
- 这种定量方法在LBBB的存在中尤其有价值,因为WMSI的可靠性较低.
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