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目的:通过腺苷负荷超声心动图评估稳定性心绞痛患者冠状动脉(冠脉)狭窄程度。方法:46例稳定性心绞痛患者在腺苷负荷前、过程中行超声心动图检查,得到二尖瓣前向血流频谱舒张早期快速充盈波(E)和舒张晚期充盈波(A)之比(E/A)、组织多普勒二尖瓣环舒张早期运动速度(E’)和舒张晚期运动速度(A’)之比(E’/A’)以及E/E’;次日行冠脉造影或冠脉计算机断层扫描。按其结果分组:正常组(n=15);冠脉狭窄50%~70%组(n=15);冠脉狭窄≥70%组(n=16)。比较组间及组内差异,行受试者工作特征曲线分析。结果:腺苷负荷前各组间各指标差异无统计学意义。腺苷负荷中正常组与冠脉狭窄≥70%组E/E’间隔差异有统计学意义(P<0.05)。腺苷负荷中冠脉狭窄≥70%组E’间隔/A’间隔、E’侧壁/A’侧壁及冠脉狭窄50%~70%组E’侧壁/A’侧壁较用药前显著降低(P均<0.05)。腺苷负荷前、过程中正常组和冠脉狭窄≥70%组△E’间隔/A’间隔差异有统计学意义(P<0.05)。受试者工作曲线显示△E’间隔/A’间隔≥0.037判定无显著冠脉狭窄(即狭窄<70%)的敏感性67%,特异性94%。结论:腺苷可诱发冠脉狭窄≥70%者左心室舒张功能降低,负荷前及过程中的△E’间隔/A’间隔≥0.037排除冠脉狭窄≥70%的特异性达到94%。
OBJECTIVE: To assess coronary artery (coronary) stenosis in patients with stable angina by adenosine stress echocardiography. Methods: Forty-six patients with stable angina pectoris underwent echocardiography before and during adenosine stress. The ratio of early filling velocity (E) and filling depth (A) / A), ratio (E ’/ A’) and E / E ’of tissue Doppler mitral annular early diastolic velocity (E’) and late diastolic velocity (A ’ Or coronary computed tomography. According to the results, the patients were divided into normal group (n = 15), coronary artery stenosis (n = 15) 50% ~ 70%, coronary stenosis≥70% (n = 16) The differences between groups and groups were compared and the job performance curves were analyzed. Results: There was no significant difference in each index between groups before adenosine stress. There was significant difference in E / E ’interval between normal group and coronary artery stenosis ≥70% (P <0.05). Adenosine stress in coronary artery stenosis ≥70% group E interval / A interval, E ’wall / A’ wall and coronary stenosis 50% ~ 70% group E ’wall / A’ (P <0.05). Adenosine load before and during the normal group and coronary stenosis ≥ 70% group △ E ’interval / A’ interval difference was statistically significant (P <0.05). Subjects working curves showed a 67% sensitivity and a 94% specificity for the determination of no significant coronary stenosis (ie, stenosis <70%) at a ΔE ’interval / A’ interval of ≥0.037. CONCLUSION: Adenosine can induce the decrease of left ventricular diastolic function in patients with coronary artery stenosis≥70%, and the specificity of △ E ’interval / A’ interval ≥0.037 before coronary artery stenosis and coronary artery stenosis≥70% can reach 94%.