Возможности контрастной стресс-эхокардиографии в выявлении ишемии миокарда у больных с различным поражением коронарного русла - Журнал Терапевтический архив №4 Вопросы диагностики внутренних болезней 2020
Возможности контрастной стресс-эхокардиографии в выявлении ишемии миокарда у больных с различным поражением коронарного русла
Атабаева Л.С., Саидова М.А., Шитов В.Н., Староверов И.И. Возможности контрастной стресс-эхокардиографии в выявлении ишемии миокарда у больных с различным поражением коронарного русла. Терапевтический архив. 2020; 92 (4): 45–50. DOI: 10.26442/00403660.2020.04.000506
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Аннотация
Цель. Сравнить диагностические возможности стандартной и миокардиальной контрастной стресс-эхокардиографии (МКСЭ) в выявлении ишемии миокарда у пациентов с различной степенью поражения коронарного русла.
Материалы и методы. Стандартная стресс-эхокардиография (стресс-ЭхоКГ) и МКСЭ проведены 38 пациентам в возрасте от 36 до 80 лет со стенозами коронарных артерий (КА) более 50% по данным коронароангиографии (КАГ). «Пограничные» (50–75%) стенозы обнаружены в 39 КА, а стенозы более 75% – в 33 КА. У 12 пациентов, в КА которых выявлены «пограничные» стенозы, проводили измерение фракционного резерва кровотока (ФРК). По данным МКСЭ, помимо оценки региональной сократимости, исследовалась также перфузия миокарда левого желудочка (ЛЖ).
Результаты. Количество сегментов ЛЖ с удовлетворительной визуализацией при введении контрастного препарата увеличилось с 81,6 до 96,1%. В отношении «пограничных» (50–75%) стенозов КА чувствительность, специфичность и точность стандартной стресс-ЭхоКГ при сравнении с КАГ составили 44, 83 и 56%, в то время как при МКСЭ эти показатели увеличивались до 56, 94 и 64% соответственно. С учетом ФРК, измеренного в 12 КА, чувствительность, специфичность и точность стандартной стресс-ЭхоКГ повышались до 52, 93 и 65%, а МКСЭ – до 68, 100 и 75%. Для стенозов более 75% чувствительность стандартной стресс-ЭхоКГ составила 78%, специфичность – 88%, точность – 80%, а при МКСЭ – 86, 100 и 92% соответственно.
Заключение. Использование ультразвуковых контрастных препаратов при стресс-ЭхоКГ значительно увеличивает информативность метода у больных с различной степенью поражения КА за счет улучшения визуализации границ эндокарда ЛЖ и дополнительной возможности оценки перфузии миокарда.
Ключевые слова: миокардиальная контрастная стресс-эхокардиография, ультразвуковые контрастные препараты, ишемия миокарда, перфузия миокарда.
Materials and methods. Myocardial contrast stress-echocardiography and standard stress-echocardiography were performed in 38 patients with coronary artery stenoses over 50% by angiography. Of all lesions 39 were intermediate (50–75%) and 33 – over 75% stenoses. Fractional flow reserve (FFR) was measured in 12 coronary arteries. During myocardial contrast stress-echocardiography wall motion and myocardial perfusion was assessed.
Results. Adequate visualisation increased from 81.6% in unenhanced segments to 96.1% in contrast-enhanced segments. The sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography in intermediate (50–75%) coronary stenoses were 44%, 83%, 56% and 56%, 94% и 64% respectively compare to angiography. Taking into account the 12 arteries with evaluated FFR, these parameters increased to 52%, 93% и 65% in standard stress-echocardiography and to 68%, 100% and 75% in myocardial contrast stress-echocardiography. In coronary stenoses over 75% the sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography were 78%, 88%, 80% and 86%, 100%, 92% respectively
Conclusion. Use of contrast-enhanced stress-echorardiography significantly increased the diagnostic value of this method by improving endocardial border visualization and possibilities of myocardial perfusion assessment.
Key words: myocardial contrast stress-echocardiography, ultrasound contrast agents, myocardial ischemia, myocardial perfusion.
Материалы и методы. Стандартная стресс-эхокардиография (стресс-ЭхоКГ) и МКСЭ проведены 38 пациентам в возрасте от 36 до 80 лет со стенозами коронарных артерий (КА) более 50% по данным коронароангиографии (КАГ). «Пограничные» (50–75%) стенозы обнаружены в 39 КА, а стенозы более 75% – в 33 КА. У 12 пациентов, в КА которых выявлены «пограничные» стенозы, проводили измерение фракционного резерва кровотока (ФРК). По данным МКСЭ, помимо оценки региональной сократимости, исследовалась также перфузия миокарда левого желудочка (ЛЖ).
Результаты. Количество сегментов ЛЖ с удовлетворительной визуализацией при введении контрастного препарата увеличилось с 81,6 до 96,1%. В отношении «пограничных» (50–75%) стенозов КА чувствительность, специфичность и точность стандартной стресс-ЭхоКГ при сравнении с КАГ составили 44, 83 и 56%, в то время как при МКСЭ эти показатели увеличивались до 56, 94 и 64% соответственно. С учетом ФРК, измеренного в 12 КА, чувствительность, специфичность и точность стандартной стресс-ЭхоКГ повышались до 52, 93 и 65%, а МКСЭ – до 68, 100 и 75%. Для стенозов более 75% чувствительность стандартной стресс-ЭхоКГ составила 78%, специфичность – 88%, точность – 80%, а при МКСЭ – 86, 100 и 92% соответственно.
Заключение. Использование ультразвуковых контрастных препаратов при стресс-ЭхоКГ значительно увеличивает информативность метода у больных с различной степенью поражения КА за счет улучшения визуализации границ эндокарда ЛЖ и дополнительной возможности оценки перфузии миокарда.
Ключевые слова: миокардиальная контрастная стресс-эхокардиография, ультразвуковые контрастные препараты, ишемия миокарда, перфузия миокарда.
________________________________________________
Materials and methods. Myocardial contrast stress-echocardiography and standard stress-echocardiography were performed in 38 patients with coronary artery stenoses over 50% by angiography. Of all lesions 39 were intermediate (50–75%) and 33 – over 75% stenoses. Fractional flow reserve (FFR) was measured in 12 coronary arteries. During myocardial contrast stress-echocardiography wall motion and myocardial perfusion was assessed.
Results. Adequate visualisation increased from 81.6% in unenhanced segments to 96.1% in contrast-enhanced segments. The sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography in intermediate (50–75%) coronary stenoses were 44%, 83%, 56% and 56%, 94% и 64% respectively compare to angiography. Taking into account the 12 arteries with evaluated FFR, these parameters increased to 52%, 93% и 65% in standard stress-echocardiography and to 68%, 100% and 75% in myocardial contrast stress-echocardiography. In coronary stenoses over 75% the sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography were 78%, 88%, 80% and 86%, 100%, 92% respectively
Conclusion. Use of contrast-enhanced stress-echorardiography significantly increased the diagnostic value of this method by improving endocardial border visualization and possibilities of myocardial perfusion assessment.
Key words: myocardial contrast stress-echocardiography, ultrasound contrast agents, myocardial ischemia, myocardial perfusion.
Список литературы
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2. Popma JJ, Chan S. Cardiac Catheterization and Percutaneous Coronary Intervention. In: Cannon CP, O’Gara PT (eds). Critical Pathways in Cardiology. Philadephia (PA): Lippincott Williams & Wilkins. 2001:142-7.
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6. Senior R, Moreo A, Gaibazzi N, et al. Comparison of sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial echocardiography to gated single photon emission computerized tomography for the detection of significant coronary artery disease: a large European multicenter study. J Am Coll Cardiol. 2013;62:1353-61.
7. Picano E. Stress Echocardiography. Sixth Edition. CNR Pisa Ist. Fisiologia Clinica. Italy, 2015.
8. Verma B, Singh A. Comparison of Contrast Enhanced Low-Dose Dobutamine Stress Echocardiography with 99mTc-Sestamibi Single-Photon Emission Computed Tomography in Assessment of Myocardial Viability. Open Access Maced J Med Sci. 2019;7(8):1287-92.
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12. Plana JC, Mikati IA, Dokainish H, et al. A randomized cross-over study for evaluation of the effect of image optimization with contrast on the diagnostic accuracy of dobutamine echocardiography in coronary artery disease: the OPTIMIZE trial. JACC Cardiovasc Imaging. 2008;1:
145-52.
13. Arnold JR, Karamitsos TD, Pegg TJ, et al. Adenosine stress myocardial contrast echocardiography for the detection of coronary artery disease: a comparison with coronary angiography and cardiac magnetic resonance. JACC Cardiovasc Imaging. 2010;3:934-43.
14. Porter TR, Adolphson M, High RR, et al. Rapid detection of coronary artery stenoses with real-time perfusion echocardiography during regadenoson stress. Circ Cardiovasc Imaging. 2011;4:628-35.
15. Gaibazzi N, Reverberi C, Lorenzoni V, et al. Prognostic value of high-dose dipyridamole stress myocardial contrast perfusion echocardiography. Circulation. 2012;126:1217-24.
16. Miszalski-Jamka T, Kuntz-Hehner S, Schmidt H, et al. Myocardial contrast echocardiography enhances long-term prognostic value of supine bicycle stress two dimensional echocardiography. J Am Soc Echocardiogr. 2009;22:1220-7.
17. Gaibazzi N, Porter T, Lorenzoni V, et al. Effect of Coronary Revascularization on the Prognostic Value of Stress Myocardial Contrast Wall Motion and Perfusion Imaging. J Am Heart Assoc. 2017;6(6). pii: e006202. doi: 10.1161/JAHA.117.006202
18. Nihoyannopoulos P, Kisslo J. Echocardiography Second Edition. Springer International Publishing AG, part of Springer Nature 2018.
19. Toth G, Hamilos M, Pyxaras S, et al. Evolving concepts of angiogram: fractional flow reserve discordances in 4000 coronary stenoses. Eur Heart J. 2014;35;2831-8.
20. Tonino PAL, Fearon WF, et al. Angiographic versus functional severity of coronary artery stenoses in the FAME Study: Fractional Flow Reserve versus angiography in multivessel evaluation. J Am Coll Cardiol. 2010;55(25):2816-21.
2. Popma JJ, Chan S. Cardiac Catheterization and Percutaneous Coronary Intervention. In: Cannon CP, O’Gara PT (eds). Critical Pathways in Cardiology. Philadephia (PA): Lippincott Williams & Wilkins. 2001:142-7.
3. Zamorano JL, Achenbach S, et al. The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34:2949-3003.
4. Porter TR, et al. Guidelines for the Cardiac Sonographer in the Performance of Contrast Echocardiography: A Focused Update from the American Society of Echocardiography. J Am Soc Echocardiogr. 2014;27(8):797-810.
5. Porter TR, Mulvagh ShL, et al. Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update. J Am Soc Echocardiogr. 2018;31(3): 241-74.
6. Senior R, Moreo A, Gaibazzi N, et al. Comparison of sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial echocardiography to gated single photon emission computerized tomography for the detection of significant coronary artery disease: a large European multicenter study. J Am Coll Cardiol. 2013;62:1353-61.
7. Picano E. Stress Echocardiography. Sixth Edition. CNR Pisa Ist. Fisiologia Clinica. Italy, 2015.
8. Verma B, Singh A. Comparison of Contrast Enhanced Low-Dose Dobutamine Stress Echocardiography with 99mTc-Sestamibi Single-Photon Emission Computed Tomography in Assessment of Myocardial Viability. Open Access Maced J Med Sci. 2019;7(8):1287-92.
9. Porter TR, Smith LM, Wu J, et al. Patient outcome following 2 different stress imaging approaches. J Am Coll Cardiol. 2013;61:2246-455.
10. Shah BN, Balaji G, Alhajiri A, et al. Incremental diagnostic and prognostic value of contemporary stress echocardiography in a chest pain unit: mortality and morbidity outcomes from a real-world setting. Circ Cardiovasc Imaging. 2013;6:202-9.
11. Thomas D, Xie F, Smith LM, et al. Prospective randomized comparison of conventional stress echocardiography and real time perfusion stress echocardiography in detecting significant coronary artery disease. J Am Soc Echocardiogr. 2012;25:1207-14.
12. Plana JC, Mikati IA, Dokainish H, et al. A randomized cross-over study for evaluation of the effect of image optimization with contrast on the diagnostic accuracy of dobutamine echocardiography in coronary artery disease: the OPTIMIZE trial. JACC Cardiovasc Imaging. 2008;1:
145-52.
13. Arnold JR, Karamitsos TD, Pegg TJ, et al. Adenosine stress myocardial contrast echocardiography for the detection of coronary artery disease: a comparison with coronary angiography and cardiac magnetic resonance. JACC Cardiovasc Imaging. 2010;3:934-43.
14. Porter TR, Adolphson M, High RR, et al. Rapid detection of coronary artery stenoses with real-time perfusion echocardiography during regadenoson stress. Circ Cardiovasc Imaging. 2011;4:628-35.
15. Gaibazzi N, Reverberi C, Lorenzoni V, et al. Prognostic value of high-dose dipyridamole stress myocardial contrast perfusion echocardiography. Circulation. 2012;126:1217-24.
16. Miszalski-Jamka T, Kuntz-Hehner S, Schmidt H, et al. Myocardial contrast echocardiography enhances long-term prognostic value of supine bicycle stress two dimensional echocardiography. J Am Soc Echocardiogr. 2009;22:1220-7.
17. Gaibazzi N, Porter T, Lorenzoni V, et al. Effect of Coronary Revascularization on the Prognostic Value of Stress Myocardial Contrast Wall Motion and Perfusion Imaging. J Am Heart Assoc. 2017;6(6). pii: e006202. doi: 10.1161/JAHA.117.006202
18. Nihoyannopoulos P, Kisslo J. Echocardiography Second Edition. Springer International Publishing AG, part of Springer Nature 2018.
19. Toth G, Hamilos M, Pyxaras S, et al. Evolving concepts of angiogram: fractional flow reserve discordances in 4000 coronary stenoses. Eur Heart J. 2014;35;2831-8.
20. Tonino PAL, Fearon WF, et al. Angiographic versus functional severity of coronary artery stenoses in the FAME Study: Fractional Flow Reserve versus angiography in multivessel evaluation. J Am Coll Cardiol. 2010;55(25):2816-21.
2. Popma JJ, Chan S. Cardiac Catheterization and Percutaneous Coronary Intervention. In: Cannon CP, O’Gara PT (eds). Critical Pathways in Cardiology. Philadephia (PA): Lippincott Williams & Wilkins. 2001:142-7.
3. Zamorano JL, Achenbach S, et al. The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34:2949-3003.
4. Porter TR, et al. Guidelines for the Cardiac Sonographer in the Performance of Contrast Echocardiography: A Focused Update from the American Society of Echocardiography. J Am Soc Echocardiogr. 2014;27(8):797-810.
5. Porter TR, Mulvagh ShL, et al. Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update. J Am Soc Echocardiogr. 2018;31(3): 241-74.
6. Senior R, Moreo A, Gaibazzi N, et al. Comparison of sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial echocardiography to gated single photon emission computerized tomography for the detection of significant coronary artery disease: a large European multicenter study. J Am Coll Cardiol. 2013;62:1353-61.
7. Picano E. Stress Echocardiography. Sixth Edition. CNR Pisa Ist. Fisiologia Clinica. Italy, 2015.
8. Verma B, Singh A. Comparison of Contrast Enhanced Low-Dose Dobutamine Stress Echocardiography with 99mTc-Sestamibi Single-Photon Emission Computed Tomography in Assessment of Myocardial Viability. Open Access Maced J Med Sci. 2019;7(8):1287-92.
9. Porter TR, Smith LM, Wu J, et al. Patient outcome following 2 different stress imaging approaches. J Am Coll Cardiol. 2013;61:2246-455.
10. Shah BN, Balaji G, Alhajiri A, et al. Incremental diagnostic and prognostic value of contemporary stress echocardiography in a chest pain unit: mortality and morbidity outcomes from a real-world setting. Circ Cardiovasc Imaging. 2013;6:202-9.
11. Thomas D, Xie F, Smith LM, et al. Prospective randomized comparison of conventional stress echocardiography and real time perfusion stress echocardiography in detecting significant coronary artery disease. J Am Soc Echocardiogr. 2012;25:1207-14.
12. Plana JC, Mikati IA, Dokainish H, et al. A randomized cross-over study for evaluation of the effect of image optimization with contrast on the diagnostic accuracy of dobutamine echocardiography in coronary artery disease: the OPTIMIZE trial. JACC Cardiovasc Imaging. 2008;1:
145-52.
13. Arnold JR, Karamitsos TD, Pegg TJ, et al. Adenosine stress myocardial contrast echocardiography for the detection of coronary artery disease: a comparison with coronary angiography and cardiac magnetic resonance. JACC Cardiovasc Imaging. 2010;3:934-43.
14. Porter TR, Adolphson M, High RR, et al. Rapid detection of coronary artery stenoses with real-time perfusion echocardiography during regadenoson stress. Circ Cardiovasc Imaging. 2011;4:628-35.
15. Gaibazzi N, Reverberi C, Lorenzoni V, et al. Prognostic value of high-dose dipyridamole stress myocardial contrast perfusion echocardiography. Circulation. 2012;126:1217-24.
16. Miszalski-Jamka T, Kuntz-Hehner S, Schmidt H, et al. Myocardial contrast echocardiography enhances long-term prognostic value of supine bicycle stress two dimensional echocardiography. J Am Soc Echocardiogr. 2009;22:1220-7.
17. Gaibazzi N, Porter T, Lorenzoni V, et al. Effect of Coronary Revascularization on the Prognostic Value of Stress Myocardial Contrast Wall Motion and Perfusion Imaging. J Am Heart Assoc. 2017;6(6). pii: e006202. doi: 10.1161/JAHA.117.006202
18. Nihoyannopoulos P, Kisslo J. Echocardiography Second Edition. Springer International Publishing AG, part of Springer Nature 2018.
19. Toth G, Hamilos M, Pyxaras S, et al. Evolving concepts of angiogram: fractional flow reserve discordances in 4000 coronary stenoses. Eur Heart J. 2014;35;2831-8.
20. Tonino PAL, Fearon WF, et al. Angiographic versus functional severity of coronary artery stenoses in the FAME Study: Fractional Flow Reserve versus angiography in multivessel evaluation. J Am Coll Cardiol. 2010;55(25):2816-21.
________________________________________________
2. Popma JJ, Chan S. Cardiac Catheterization and Percutaneous Coronary Intervention. In: Cannon CP, O’Gara PT (eds). Critical Pathways in Cardiology. Philadephia (PA): Lippincott Williams & Wilkins. 2001:142-7.
3. Zamorano JL, Achenbach S, et al. The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34:2949-3003.
4. Porter TR, et al. Guidelines for the Cardiac Sonographer in the Performance of Contrast Echocardiography: A Focused Update from the American Society of Echocardiography. J Am Soc Echocardiogr. 2014;27(8):797-810.
5. Porter TR, Mulvagh ShL, et al. Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update. J Am Soc Echocardiogr. 2018;31(3): 241-74.
6. Senior R, Moreo A, Gaibazzi N, et al. Comparison of sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial echocardiography to gated single photon emission computerized tomography for the detection of significant coronary artery disease: a large European multicenter study. J Am Coll Cardiol. 2013;62:1353-61.
7. Picano E. Stress Echocardiography. Sixth Edition. CNR Pisa Ist. Fisiologia Clinica. Italy, 2015.
8. Verma B, Singh A. Comparison of Contrast Enhanced Low-Dose Dobutamine Stress Echocardiography with 99mTc-Sestamibi Single-Photon Emission Computed Tomography in Assessment of Myocardial Viability. Open Access Maced J Med Sci. 2019;7(8):1287-92.
9. Porter TR, Smith LM, Wu J, et al. Patient outcome following 2 different stress imaging approaches. J Am Coll Cardiol. 2013;61:2246-455.
10. Shah BN, Balaji G, Alhajiri A, et al. Incremental diagnostic and prognostic value of contemporary stress echocardiography in a chest pain unit: mortality and morbidity outcomes from a real-world setting. Circ Cardiovasc Imaging. 2013;6:202-9.
11. Thomas D, Xie F, Smith LM, et al. Prospective randomized comparison of conventional stress echocardiography and real time perfusion stress echocardiography in detecting significant coronary artery disease. J Am Soc Echocardiogr. 2012;25:1207-14.
12. Plana JC, Mikati IA, Dokainish H, et al. A randomized cross-over study for evaluation of the effect of image optimization with contrast on the diagnostic accuracy of dobutamine echocardiography in coronary artery disease: the OPTIMIZE trial. JACC Cardiovasc Imaging. 2008;1:
145-52.
13. Arnold JR, Karamitsos TD, Pegg TJ, et al. Adenosine stress myocardial contrast echocardiography for the detection of coronary artery disease: a comparison with coronary angiography and cardiac magnetic resonance. JACC Cardiovasc Imaging. 2010;3:934-43.
14. Porter TR, Adolphson M, High RR, et al. Rapid detection of coronary artery stenoses with real-time perfusion echocardiography during regadenoson stress. Circ Cardiovasc Imaging. 2011;4:628-35.
15. Gaibazzi N, Reverberi C, Lorenzoni V, et al. Prognostic value of high-dose dipyridamole stress myocardial contrast perfusion echocardiography. Circulation. 2012;126:1217-24.
16. Miszalski-Jamka T, Kuntz-Hehner S, Schmidt H, et al. Myocardial contrast echocardiography enhances long-term prognostic value of supine bicycle stress two dimensional echocardiography. J Am Soc Echocardiogr. 2009;22:1220-7.
17. Gaibazzi N, Porter T, Lorenzoni V, et al. Effect of Coronary Revascularization on the Prognostic Value of Stress Myocardial Contrast Wall Motion and Perfusion Imaging. J Am Heart Assoc. 2017;6(6). pii: e006202. doi: 10.1161/JAHA.117.006202
18. Nihoyannopoulos P, Kisslo J. Echocardiography Second Edition. Springer International Publishing AG, part of Springer Nature 2018.
19. Toth G, Hamilos M, Pyxaras S, et al. Evolving concepts of angiogram: fractional flow reserve discordances in 4000 coronary stenoses. Eur Heart J. 2014;35;2831-8.
20. Tonino PAL, Fearon WF, et al. Angiographic versus functional severity of coronary artery stenoses in the FAME Study: Fractional Flow Reserve versus angiography in multivessel evaluation. J Am Coll Cardiol. 2010;55(25):2816-21.
Авторы
Л.С. Атабаева, М.А. Саидова, В.Н. Шитов, И.И. Староверов
Научно-исследовательский институт клинической кардиологии им. А.Л. Мясникова ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
Myasnikov Insitute of Clinical Cardiology, National Medical Research Center for Cardiology, Moscow, Russia
Научно-исследовательский институт клинической кардиологии им. А.Л. Мясникова ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
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Myasnikov Insitute of Clinical Cardiology, National Medical Research Center for Cardiology, Moscow, Russia
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