Doppler and Stress Echocardiography in Diagnosis of Latent Coronary Insufficiency

97 patients (62 men and 35 women) aged from 38 up to 74 years old (56 ± 8 years) were examined. X-ray coronary angiography was performed in all patients. It was the main inclusion criterion. There were two groups: control group - patients without coronary artery disease (n = 48, 28 men and 20 women), study group - patients with coronary artery disease (n = 49, 34 men and 15 women). The study group was divided into two subgroups: patients with stenosis of left anterior descending artery (35) and right coronary artery (14). All patients underwent Doppler echocardiography and bicycle stress echocardiography. The use of combined technology (Doppler echocardiography and bicycle stress echocardiograph) showed the highest sensitivity (90%) and specificity (94%) and being the most available and safe method of the latent coronary insufficiency diagnosis. The highest reliability of two technologies was shown in diagnosis of left anterior descending coronary artery stenosis because of its more close location to the anterior thoracic wall. The diagnosis of right coronary artery stenosis with two technologies was much less reliable due to the remoteness of posterior wall and vascular anatomy complexity.

допплерэхокардиография, велоэргометрическая стресс-эхокардиография, ишемическая болезнь сердца, передняя нисходящая артерия, правая коронарная артерия, doppler echocardiography, bicycle stress echocardiography, coronary artery disease, left anterior descending artery, right coronary artery

1. Abusaid G.H., Ahmad M. Real time three-dimensional stress echocardiography advantages and limitations // Echocardiography. 2012. V. 29. No. 2. P. 200-206.

2. Chatzizisis Y.S., Murthy V.L., Solomon S.D. Echocardiographic evaluation of coronary artery disease // Coron. Artery Dis. 2013. V. 24. No. 7. Р. 613-623.

3. Miszalski-Jamka T., Kuntz-Hehner S., Tiemann K. et al. Quantitative myocardial contrast supine bicycle stress echocardiography for detection of coronary artery disease // Echocardiography. 2013. V. 30. No. 4. Р. 392-400.

4. Peteiro J., Bouzas-Mosquera A., Estevez R. et al. Head-to-head comparison of peak supine bicycle exercise echocardiography and treadmill exercise echocardiography at peak and at post-exercise for the detection of coronary artery disease // J. Am. Soc. Echocardiogr. 2012. V. 25. No. 3. Р. 319-326.

5. Picano E., Pellikka P.A. Stress echo applications beyond coronary artery disease // Eur. Heart J. 2014. V. 35. No. 16. Р. 1033-1040.

6. Бощенко А.А., Врублевский А.В., Карпов Р.С. Трансторакальное ультразвуковое исследование резерва коронарного кровотока: патофизиологические, методические и клинические аспекты // Ультразвуковая и функциональная диагностика. 2011. № 5. С. 36-56.

7. Бощенко А.А. Комплексная неинвазивная ультразвуковая оценка коронарного кровотока и коронарного резерва у больных ишемической болезнью сердца: Автореф. дис.. докт. мед. наук. Томск: Научно-исследовательский институт кардиологии, 2014. 50 с.

8. Павлюкова Е.Н., Трубина Е.В., Карпов Р.С. Скорости кровотока в дистальном сегменте передней нисходящей коронарной артерии у больных ишемической и дилатационной кардиомиопатией // Ультразвуковая и функциональная диагностика. 2011. № 1. С. 56-64.

9. Zagatina A., Zhuravskaya N. Transthoracic detection of coronary flow in left and right coronary descending arteries during supine bicycle stress echocardiography // Coron. Artery Dis. 2012. V. 23. No. 5. Р. 337-347.

10. Практическая эхокардиография: Руководство по эхокардиографической диагностике / Под ред. Ф.А. Флакскампфа. Пер. с нем. под ред. В.А. Сандрикова. М.: МЕДпресс-информ, 2013. 872 с.

11. Cortigiani L., Rigo F., Gherardi S. et al. Prognostic implication of Doppler echocardiographic derived coronary flow reserve in patients with left bundle branch block // Eur. Heart J. 2013. V. 34. No. 5. Р. 364-373.

12. Gaibazzi N., Rigo F., Lorenzoni V. et al. Comparative prediction of cardiac events by wall motion, wall motion plus coronary flow reserve, or myocardial perfusion analysis: a multicenter study of contrast stress echocardiography // JACC Cardiovasc. Imaging. 2013. V. 6. No. 1. P. 1-12.

13. Thomas D., Xie F., Smith L.M. 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. V. 25. No. 11. Р. 1207-1214.

14. Bossuyt P.M., Reitsma J.B., Bruns D.E. et al. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative // Clin. Chem. Lab. Med. 2003. V. 41. No. 1. Р. 68-73.

15. Михеев Н.Н. Стресс-эхокардиография в диагностике поздних стенозов аортокоронарных шунтов // Радиология-практика. 2012. № 2. С. 24-31.

16. Михеев Н.Н. Чреспищеводная стресс-эхокардиография с комбинированными агентами в диагностике ишемической болезни сердца // Радиология-практика. 2015. № 2. С. 6-13.