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Kokyu to Junkan Volume 43, Issue 7 （July 1995）

呼吸と循環 43巻7号（1995年7月発行）

Japanese English

研究

ジピリダモール負荷心エコー法による虚血性心疾患の診断—fixed wall motionを含めた検討 Diagnosis of Ischemic Heart Disease by Dipyridamole Stress Echocardiography:Evaluation of the diagnostic criterion including fixed wall motion 平野豊 ¹ , 山本忠彦 ¹ , 佐々木剛 ¹ , 内藤武夫 ¹ , 井川寛 ¹ , 土生裕史 ¹ , 岡林靖之 ¹ , 塩谷英一 ¹ , 宮崎俊夫 ¹ , 石川欽司 ¹ , 香取瞭 ¹ Yutaka Hirano ¹ , Tadahiko Yamamoto ¹ , Takeshi Sasaki ¹ , Takeo Naito ¹ , Hiroshi Ikawa ¹ , Hirofumi Habu ¹ , Yasuyuki Okabayashi ¹ , Eiichi Enya ¹ , Toshio Miyazaki ¹ , Kinji Ishikawa ¹ , Ryo Katori ¹ ¹近畿大学医学部第一内科 ¹The First Department of Internal Medicine, Kinki University School of Medicine キーワード：虚血性心疾患 , ジピリダモール , 超音波断層法 , dipyridamole , echocardiography , ischemic heart disease Keyword: 虚血性心疾患 , ジピリダモール , 超音波断層法 , dipyridamole , echocardiography , ischemic heart disease pp.681-686

発行日 1995年7月15日 Published Date 1995/7/15

DOI https://doi.org/10.11477/mf.1404901083

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Abstract 文献概要
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　ジピリダモール負荷心エコー法において壁運動異常の判定基準を変えることにより虚血性心疾患の診断精度がどの程度変わるか検討した．虚血性心疾患を疑って心臓カテーテル検査を施行した45例を対象とし，本法の壁運動悪化のみを陽性とした場合の有意冠動脈狭窄に対する感度，特異度，正確度はそれぞれ61％，100％，76％であった．壁運動の悪化のみならず不変を陽性基準とすることにより感度，特異度，正確度はそれぞれ86％，94％，89％となった．本法は運動負荷心電図（71％，53％，64％）より感度，特異度，正確度とも高く，運動負荷²⁰¹Tl心筋シンチ（89％，71％，82％）とほぼ同等であった．ジピリダモール負荷心エコー法は壁運動異常の悪化のみならず不変を陽性の診断基準とすることにより運動負荷²⁰¹Tl心筋シンチとほぼ同等の診断精度を有すると考える．

Dipyridarnole stress echocardiography test (DSET) has been a potential alternative to exercise ECG for diagnosing coronary artery disease. However, whether lack of hyperdynamic response to DSET could be a marker of myocardial ischemia comparable with new wall motion abnormalities remains uncertain. To address this question, we compared a combination offixed and worsening wall motion by DSET with worsen-ing wall motion alone as criteria for diagnosing coro-nary artery stenosis (%stenosis greater than 75%). DSET, 0.84 mg/min over 10 min, was performed in 45 patients with suspected coronary artery disease, and echo images were evaluated semiquantitatively using digital quad-screen format. A fixed wall motion was defined as no worsening or improvement in wall motion from baseline echocardiogram. Coronary angiographv and exercise thallium-201 scintigraphy were carried out in all patients. When the worsening wall motion in-duced by dipyridamole was considered positive for coronary artery disease, the sensitivity, specificity and diagnostic accuracy of the DSET were 61% (17/28). 100% (17/17) and 80% (34/45). respectively. When both the worsening and fixed wall motion were consid-ered positive, the sensitivity, specificity and diagnostic accuracy were 86% (24/28), 94% (16/17) and 89% (40/ 45), respectively. The sensitivity, specificity and diag-nostic accuracy for exercise thallium-201 scintigraphy were 89% (25/28), 71% (12/17), 82% (37/45), respec-tively. Side effects were observed in 53% (24/45) of patients, but were all mild and transient.

In conclusion, under the diagnostic criterion including fixed wall motion, DSET demonstrated a similar sensi-tivity and specificity for detection of coronary artery stenosis compared with exercise thallium-201 scintigra-phy.