潘生丁
医学
多巴酚丁胺
负荷超声心动图
心脏病学
内科学
冠状动脉疾病
腺苷
压力测试(软件)
交叉研究
血流动力学
病理
替代医学
计算机科学
程序设计语言
安慰剂
作者
Timothy W. Martin,John F. Seaworth,Joseph P. Johns,Lawrence E. Pupa,W R Condos
标识
DOI:10.7326/0003-4819-116-3-190
摘要
Objective: To compare adenosine, dipyridamole, and dobutamine in stress echocardiography with regard to sensitivity, specificity, accuracy, and side effects. ▪Design: Crossover, blinded comparison, with coronary angiography serving as the criterion standard. ▪Setting: U.S. Army tertiary care hospital. Participants: Forty participants, 25 with coronary disease and 15 without coronary disease. Patients were eligible if they had coronary angiography within 6 weeks of stress testing or if they had a risk for coronary disease of less than 5%. Measurements: Left ventricular wall motion was recorded after dobutamine (0.38 mg/kg body weight), adenosine (0.84 mg/kg body weight), and dipyridamole (0.84 mg/kg body weight) stress testing. Stress echocardiographic evaluation was considered to be abnormal if the patient developed new or progressive wall motion abnormalities. The rate of side effects for the types of echocardiography and the patient preference were recorded. Main Results: The sensitivity of dobutamine stress echocardiography (76%; 95% Cl, 59% to 93%) was significantly higher than that of adenosine echocardiography (40%; Cl, 21 % to 59%; P〈0.001) and that of dipyridamole echocardiography (56%; Cl, 37% to 75%; P = 0.019). The specificity of adenosine testing (93%; Cl, 80% to 100%) was significantly higher than that of dobutamine echocardiography (60%; Cl, 35% to 85%; P = 0.008) and that of dipyridamole echocardiography (67%; Cl, 43% to 91%; P= 0.028). Symptoms were more frequent with adenosine echocardiography (100%) than with dipyridamole (88%; P〈0.001) or dobutamine (80%; P〈0.001) echocardiography. Treatmentfor persistent symptoms was required in more patients after dipyridamole echocardiography (40%) than after dobutamine (12%; P〈0.001) or adenosine (0%; P〈.001) echocardiography. More patients preferred dobutamine (48%) or dipyridamole (40%) echocardiography to adenosine echocardiography (12%; P〈0.001). Conclusions: Dobutamine stress echocardiography is more sensitive and is better tolerated than adenosine or dipyridamole stress echocardiography. Adenosine echocardiography is more specific than dobutamine or dipyridamole echocardiography and is less likely to cause persistent symptoms.
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