Comparative efficiency of bicycle stresses-echocardiography and dopplerography of coronary arteries in diagnosis of the latent coronary insufficiency

Modern angiographic and stressful ultrasonic technologies possess the big possibilities in diagnostics of the latent coronary insufficiency. Purpose. To compare sensitivity and specificity of bicycle stress-echocardiography, dopplerography of coronary arteries and combined method in diagnostics of significant stenosis of coronary arteries were used. Design/methodology/approach. Two groups of patients were analyzed: 35 persons from more than 50 % stenosis of coronary arteries and 39 persons without significant stenosis. Dopplerography of coronary arteries and stress-echocardiography were performed in all patients. The ROC-analysis of sensitivity and specificity of each method and the combined technology in diagnostics of the general CAD, left anterior-descending CAD, and the right coronary CAD was spent. Findings. The dopplerography of coronary arteries has shown sensitivity of 77 %, specificity of 97 %, for LAD - 81 and 97 %, for RA - 50 and 98 %. The stress-echocardiography has shown sensitivity of 83 %, specificity of 95 %, for LAD - 89 and 95 %, for RA - 63 and 98 % The combined technique has shown sensitivity of 93 %, specificity - 95 %, for LAD - 96 and 94 %, for RA - 75 and 98 %. Conclusion. The combined technique is characterized by the robust reproducibility at the expense of revealing of loading infringements local contractility of myocardium in patients with not detected stenosis, and also at the expense of revealing of vascular narrowing in persons with well developed indemnification of deficiency of a blood-groove on the changed vessel.

ИБС, скрытая коронарная недостаточность, допплерография коронарных артерий, стресс-эхокардиография, CAD, latent coronary insufficiency, dopplerography of coronary arteries, stress-echocardiography

1. Абалмасов В. Г., Тривоженко А. Б., Стручков П. В. Трансторакальная и чреспищеводная стрессэхокардиография. М.: Медпрактика-М, 2012. 96 с.

2. Аронов Д. М., Лупанов В. П. Функциональные пробы в кардиологии. 3-е изд., перераб. и доп. М.: МЕДпрессинформ, 2007. 328 с.

3. Бощенко А. А., Врублевский А. В., Карпов Р. С. Трансторакальное ультразвуковое исследование магистральных коронарных артерий: методические аспекты, возможности, ограничения // Ультразвук. и функц. диагностика. 2008. № 6. С. 60-74.

4. Бощенко А. А., Врублевский А. В., Карпов Р С. Диагностика гемодинамически значимого стенозирования передней нисходящей коронарной артерии с помощью трансторакального ультразвукового исследования абсолютного и относительного резервов коронарного кровотока // Сибир. мед. журн. 2010. № 2. С. 79-80.

5. Практическая эхокардиография: рук-во по эхокардиографической диагностике / под ред. Ф. Франка Флакскампфа; пер. с нем.; под общ. ред. акад. РАМН, проф. В. А. Сандрикова. М.: МЕДпресс-информ, 2013. 872 с.

6. Рыбакова М. К., Алехин М. Н., Митьков В. В. Практическое руководство по ультразвуковой диагностике. Эхокардиография. 2-е изд., испр. и доп. М.: Видар-М, 2008. 544 с.

7. Anjaneyulu A., Raghu K., Chandramukhi S. et al. Evaluation of left main coronary artery stenosis by transthoracic echocardiography // J. Am. Soc. Echocardiogr. 2008. Vol. 21. № 7. P. 855-860.

8. Claus P, Weidemann F, Dommke C. et al. Mechanisms of postsystolic thickening in ischemic myocardium: mathematical modelling and comparison with experimental ischemic substrates // Ultrasound Med. Biol. 2007. Vol. 33. Р. 1963-1970.

9. Innocenti F., Lazzeretti D., Conti A. et. al. Stress echocardiography in the ed: diagnostic performance in high-risk subgroups // American Journal Of Emergency Medicine. 2013. Vol. 31. № 9. Р. 1309-1314.

10. Picano E. Stress Echocardiography. Fifth, completely revised and updated edition. Springer-Verlag, BerlinHeidelberg, 2009. 630 р.

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

12. Rigo F., Murer B., Ossena G. et al. Transthoracic echocardiographic imaging of coronary arteries: tips, traps, and pitfalls // Cardiovasc Ultrasound. 2008. Vol. 6. Р. 7-12.

13. Soylu O., Celik S., Karakus G. et al. Transthoracic doppler echocardiographic coronary flow imaging in identification of left anterior descending coronary artery stenosis in patients with left bundle branch block // Echocardiography. 2008. Vol. 25. P. 1065-1070.

14. Vegsundvag J., Holte E., Wiseth R. et al. Transthoracic echocardiography for imaging of the different coronary artery segments: A Feasibility Study // Cardiovasc. Ultrasound. 2009. Vol. 7. Р. 79-90.