负荷超声对扩张型心肌病与缺血性心肌病鉴别诊断价值初探.doc

???? 负荷超声对扩张型心肌病与缺血性心肌病鉴别诊断价值初探 ???? ????【摘要】　目的　观察扩张型心肌病(DCM)及缺血性心肌病(ICM)患者在多巴酚丁胺负荷超声心动(DSE)中的室壁运动规律。方法　18例心脏扩大、心力衰竭患者微泵滴注多巴酚丁胺、按5 μg/(kg．min)、10 μg/(kg．min)、20 μg/(kg．min)、30 μg/(kg．min)、40 μg/(kg．min)的顺序递增，每个剂量持续3分钟。全程连续观察超声心动并记录。全部患者同期行冠脉造影检查。结果　①随药物剂量逐级递增，DCM患者左室舒张末径缓慢缩小、左室射血分数持续增加；ICM患者左室舒张末径无明显变化，左室射血分数仅在低剂量时增加。②高剂量时节段室壁运动异常在DCM患者中占14%，在ICM患者中占80%。二者比较有显著差异(P＜0.01)。③根据高剂量时节段室壁运动异常预测ICM，其敏感性80%，特异性87%，阳性预测值88%，阴性预测值77%。结论　DSE试验有助于临床对DCM及ICM的鉴别诊断。　　【关键词】　多巴酚丁胺　负荷超声心动　扩张型心肌病　缺血性心肌病 Value of dobutamine stress echocardiography in distinguishing between dilated cardiomyopathy and ischemic cardiomyopathy Hou Yueshuang, He Yale, Huang Xinsheng（Guangdong Cardiovascular Institute, Guangzhou 510080） 　　【Abstract】　Objective　To investigate the ventricular wall motion rule of the patients (pts) with dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM) by dobutamine stress echocardiography (DSE). Methods　18 pts with cardiac dilatation and cardiac failure underwent DSE. Dobutamine was infused by a pump and increased with the doses of 5 μg/(kg．min), 10 μg/(kg．min), 20 μg/(kg．min),30 μg/(kg．min),40 μg/(kg．min) every 3 minutes. All procedure was detected by echocadiography and was recorded. Results　① While dobutamine increased gradually, the left ventricle diastolic dimension (LVDd) of the pts with DCM decreased slowly and left ventricle ejection fraction (LVEF) increased continually; but the LVDd of the pts with ICM changed insignificantly, LVEF increased only at low doses. ② At high doses, the incidence of regional wall motion abnormalities (RWMA) was 14% in pts with DCM, and 80% in pts with ICM. ③ According to the regional wall motion abnormalities at high doses, the sensitivity, specificity, positive predictive values and negative predictive value for predicting ICM were 80%, 87%, 88% and 77% respectively. Conclusion　To observe on the LVDd, LVEF and RWMA in DSE might help to distinguish between DCM and ICM clinically.　　【Key words】　Dobatamine Stress echocardio