Jong-Hoa Bae： 运动负荷超声心动图

Jong-Hoa Bae, MD, Kyung Hee Univeristy, Seoul, Korea


Jong-Hoa Bae博士


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Exercise testing has been used to evaluate the ischemic heart disease in clinical practice for many years and its use has contributed significantly but the diagnostic usefulness of exercise ECG is limited. After Tennant and Wiggers demonstrated systolic bulging in the area of ischemia in dogs by coronary artery ligation, techniques have been sought to directly visualize ischemic ventricular wall motion abnormalities. Previous reports for exercise echocardiography results compared to exercise ECG are reported more than 80% sensitivity and 90% specificity. In our institution,

we performed treadmill exercise echocardiography using modified Bruce protocol in patients with chest pain syndrome. The sensitivity of exercise ECG revealed 61% and specificity 55%, and  sensitivity of exercise echocardiography revealed 81% and specificity 88%. And positive predictive value of exercise echocardiography was 88%, negative predictive value was 83%. The assessment of regional wall motion using conventional 2DE has advantages such as leading real-time imaging modality, sensitive and cost-effective. But clinical studies have shown that the visual interpretation of stress echocardiographic images can be qualitative, subjective and highly operator dependent, being influenced both by the expertise of the examiner and the acquired image quality. Prior attempts to use Doppler to quantify myocardial velocities have been on spectral analysis of pulsed wave Doppler myocardial imaging by measuring instantaneous myocardial velocities.

Such a pulsed wave Doppler methods has the advantages of a high temporal resolution, true peak myocardial velocities and studies have shown reproducible changes during ischemia. But it is somewhat impractical for use because data acquisition must be carried out in real time and angle dependent. A new generation Color Doppler Myocardial Imaging system with high temporal and spatial resolution has been developed with frame rates of 60 - 80 per second that allows real-time acquisition of color Doppler images with subsequent off-line computer analysis of regional mean velocities. Another approach to defining regional myocardial properties could be to evaluate the deformation properties of a myocardial segment during the cardiac cycle. This can be described by its strain rate which is the rate of the length change over time and did not influenced by global heart motion such as translation or rotation. Therefore, the clinical value of exercise echocardiography is definite for those patients with previous nondiagnostic routine treadmill ECG test, high likelihood false positive treadmill ECG test, and for evaluation of the extent and localization of ischemia, prior to and following intervention, and post myocardial infarction prognosis.

 

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