平野 豊, 山本 忠彦, 佐々木 剛, 上原 久和, 土生 裕史, 井川 寛, 内藤 武夫, 宮崎 俊夫, 石川 欽司, 香取 瞭

Yutaka HIRANO, Tadahiko YAMAMOTO, Takeshi SASAKI, Hisakazu UEHARA, Hirofumi HABU, Hiroshi IKAWA, Takeo NAITO, Toshio MIYAZAKI, Kinji ISHIKAWA, Ryo KATORI

近幾大学第1内科

First Department of Internal Medicine Kinki University School of Medicine

キーワード : Dipyridamole, Coronary artery disease , Exercise, Stress echocardiography

To compare their feasibility, sensitivity, and specificity in the diagnosis of significant coronary stenosis, dipyridamole echocardiography and exercise echocardiography were administered to 50 patients suspected of having coronary artery disease. Dipyridamole was infused at 0.14 mg/kg per minute for 4 minutes, and 4 minutes later was reinfused at the same dose for 2 minutes. Exercise was performed using a supine bicycle ergometer. Initial workload was 50 W and was increased in increments of 25 W every 3 minutes up to a maximum of 150 W. Two-dimensional echocardiographic images were digitized and assigned in a quad-screen format for nonbiased interpretation. The image quality score index was the sum of the image quality scores of all views. All patients underwent selective coronary arteriography. Overall sensitivity and specificity of dipyridamole and exercise echocardiography in the diagnosis of coronary artery stenosis (≥75%) were 83% (35/42) and 88% (7/8), 88% (37/42) and 75% (6/8), respectively. Sensitivity of dipyridamole and exercise echocardiography in the diagnosis of one-vessel disease were 73% (16/22) and 82% (18/22), respectively. Image quality score index of dipyridamole echocardiography was higher than that of exercise echocardiography. No major complications occurred during either test. We concluded that both dipyridamole and exercise echocardiography demonstrated nearly the same overall sensitivity and specificity for diagnosing coronary artery stenosis. Dipyridamole had better image quality and slightly lower sensitivity to single-vessel coronary artery disease, however.