Background

The diagnostic value of limited myocardial ischemia in DSE is not well-known.

Objectives

We investigated whether myocardial ischemia during dobutamine stress echocardiography (DSE) in 1 apical segment of any of the ventricular walls of the left ventricle relates to the anatomical and functional stenosis of the suppling coronary artery.

Methods

Our observational, prospective study enrolled 212 patients, symptomatic or asymptomatic, with newly diagnosed limited myocardial ischemia on DSE. Almost 25% of them had already known CAD, while the rest were divided into low-risk and high-risk group integrating 1-2 and ≥3 classical cardiovascular risk factors, respectively. After DSE, all patients underwent invasive coronary angiography (ICA) and were followed-up for one year. In coronary arteries distributing ischemic area, the calculated stenosis ≥50% and FFR<0.8 were considered as anatomically and functionally significant, respectively. In the latter cases, the patients underwent coronary revascularization.

Results

Significant anatomical and functional stenosis of the supplying coronary artery was common among patients with already known CAD (62.5%, 44.5%, respectively) or those without CAD but high-risk profile (60.2%, 25.6%, respectively). In logistic regression analysis, CAD revascularization was independently determined by already known CAD, diabetes mellitus and high-risk profile. During follow-up, 24 patients experienced ACS or new angina episodes, which were associated with diabetes and smoking in univariate analysis.

Conclusion

Limited myocardial ischemia may implicate significant anatomical and functional coronary stenosis among individuals with history of CAD or those without known CAD but high-risk profile. The prognostic value of our findings require further investigation.

中文翻译：

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负荷超声心动图对高危患者局限性心肌缺血的诊断价值

背景

DSE 中局限性心肌缺血的诊断价值尚不清楚。

目标

我们研究了多巴酚丁胺负荷超声心动图（DSE）期间左心室任何心室壁心尖段的心肌缺血是否与供应冠状动脉的解剖学和功能性狭窄有关。

方法

我们的观察性前瞻性研究纳入了 212 名有症状或无症状的患者，这些患者在 DSE 上新诊断出有限的心肌缺血。其中近 25% 的人已知 CAD，其余的则分为低风险组和高风险组，分别结合 1-2 个和≥3 个经典心血管危险因素。DSE 后，所有患者均接受侵入性冠状动脉造影（ICA）并随访一年。在分布缺血区的冠状动脉中，计算出的狭窄≥50%和FFR<0.8分别被认为具有解剖学和功能上的显着性。在后一种情况下，患者接受了冠状动脉血运重建术。

结果

在已知患有 CAD 的患者（分别为 62.5% 和 44.5%）或没有 CAD 但具有高风险特征的患者（分别为 60.2% 和 25.6%）中，供应冠状动脉显着的解剖学和功能性狭窄很常见。在逻辑回归分析中，CAD 血运重建是根据已知的 CAD、糖尿病和高危情况独立确定的。随访期间，24 名患者出现 ACS 或新发心绞痛发作，单变量分析表明这些症状与糖尿病和吸烟有关。

结论

对于有 CAD 病史的个体或没有已知 CAD 但具有高风险特征的个体，有限的心肌缺血可能意味着显着的解剖学和功能性冠状动脉狭窄。我们的研究结果的预后价值需要进一步研究。