Skip to main content
SpringerLink
Log in

Stellenwert der pharmakologischen Belastungsechokardiographie

  • Chapter
Echokardiographische Diagnostik bei koronarer Herzkrankheit

Zusammenfassung

In der Diagnostik der koronaren Herzkrankheit ist die Identifikation ischämiegefährdeter Myokardbezirke sowie deren Lokalisation und Ausdehnung für das weitere therapeutische Vorgehen und die Prognose des Patienten von elementarer Bedeutung. Angioplastie oder revaskularisierende Maßnahmen sind nur dann sinnvoll, wenn neben der Koronarmorphologie auch die hämodynamische Relevanz von Stenosen, das Versorgungsgebiet des betroffenen Gefäßes und die Vitalität der zu erhaltenden Myokardbezirke exakt bekannt sind. Die Belastungsergometrie stellt seit ihrer klinischen Einführung in den 50er Jahren die diagnostische Methode der 1. Wahl zur Klärung der genannten Fragen dar [17, 18]. Ihr Aussagewert wurde in den letzten Jahrzehnten durch die Einführung myokardszintigraphischer Verfahren deutlich erweitert [4, 30, 31, 66, 68].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

Literatur

  1. Agati L, Renzi M, Sciomer S et al. (1992) Transesophageal dipyridamole echocardiography for diagnosis of coronary artery disease. J Am Coll Cardiol 19:765–770

    Article  PubMed  CAS  Google Scholar 

  2. Armstrong WF, O’Donell J, Dillon JC et al. (1986) Complementary value of two-dimensional exercise echocardiography to routine treadmill exercise testing. Ann Intern Med 105:829–835

    PubMed  CAS  Google Scholar 

  3. Belardinelli L, Linden J, Berne RM (1989) The cardiac effects of adenosine. Prog Cardiovasc Dis 32:73–97

    Article  PubMed  CAS  Google Scholar 

  4. Beller GA, Gibson RS (1987) Sensitivity, specificity and prognostic significance of noninvasive testing for occult or known coronary artery disease. Prog Cardiovasc Dis 4:241–270

    Article  Google Scholar 

  5. Berne RM (1980) The role of adenosine in the regulation of coronary blood flow. Circ Res 47:807–813

    PubMed  CAS  Google Scholar 

  6. Berthe C, Pierard LA, Hiernaux M et al. (1991) Predicting the extend and location of coronary artery disease in acute myocardial infarction by echocardiography during dobutamine infusion. Am J Cardiol 58:1167–1172

    Article  Google Scholar 

  7. Boccanelli A, Piazza V, Greco C et al. (1993) Comparison of diagnostic value of dipyridamole and dobutamine stress echocardiography in the diagnosis of coronary artery disease (abstr.) J Am Coll Cardiol 21:393 A

    Google Scholar 

  8. Bolognese L, Sarasso G, Aralda D et al. (1989) High dose dipyridamole echocardiography early after uncomplicated myocardial infarction: correlation with exercise testing and coronary angiography. J Am Coll Cardiol 14:357–363

    Article  PubMed  CAS  Google Scholar 

  9. Cerqueira MD, Verani MS, Heo J Iskandrian AS for the Adenoscan Multicenter Trial Investigators (1992) Safety profile of adenosine stress perfusion imaging in 9256 patients: Results from the registry for the Adenoscan Multicenter Trial (abstr.). Circulation 86 (Suppl. I): I–185

    Google Scholar 

  10. Cohen JL, Greene TO, Ottenweller J et al. (1991) Dobutamine digital echocardiography for detecting coronary artery disease. Am J Cardiol 67:1311–1318

    Article  PubMed  CAS  Google Scholar 

  11. Coma-Canella I (1991) Dobutamine stress test to diagnose the presence and severity of coronary artery lesions in angina. Eur Heart J 12:1198–1204

    Article  PubMed  CAS  Google Scholar 

  12. DiMarco JP, Sellers TD, Berne RM et al. (1983) Adenosine: electrophysiologic effects and therapeutic use for terminating paroxysmal supraventricular tachycardia. Circulation 68:1254–1263

    Article  PubMed  CAS  Google Scholar 

  13. Dole WP (1987) Autoregulation of the coronary circulation. Prog Cardiovasc Dis 29:293–323

    Article  PubMed  CAS  Google Scholar 

  14. Elliot EC (1961) The effect of persantine on coronary flow and cardiac dynamics. Can Med Assoc J 85:469–476

    PubMed  CAS  Google Scholar 

  15. Ferrara N, Bonaduce D, Leosco D et al. (1986) Two-dimensional echocardiographic evaluation of ventricular asynergy induced by dipyridamole: correlation with thallium scanning. Clin Cardiol 9:437–442

    Article  PubMed  CAS  Google Scholar 

  16. Fitzgerald GA (1987) Dipyridamole. N Engl J Med 316:1247–1257

    Article  PubMed  CAS  Google Scholar 

  17. Gianrossi R, Detrano R, Mulvihill D et al. (1989) Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta analysis. Circulation 80:87–98

    Article  PubMed  CAS  Google Scholar 

  18. Gibson RS (1991) The diagnostic and prognostic value of exercise electrocardiography in asymptomatic subjects and stable symptomatic patients. Curr Opin Cardiol 6:536–546

    Article  PubMed  CAS  Google Scholar 

  19. Gould KL, Lipscomb K, Hamilton GW (1974) Physiologic basis for assessing critical coronary stenosis. Am J Cardiol 33:87–94

    Article  PubMed  CAS  Google Scholar 

  20. Gould KL (1978) Noninvasive assessment of coronary stenosis by myocardial perfusion imaging during pharmacologic coronary vasodilation. I. Physiologic basis and experimental validation. Am J Cardiol 41:267–278

    Article  PubMed  CAS  Google Scholar 

  21. Gould KL, Westcott RJ, Albro PC, Hamilton GW (1978) Noninvasive assessment of coronary stenosis by myocardial perfusion imaging during pharmacologic coronary vasodilation. II. Clinical methodology and feasibility. Am J Cardiol 41:279–287

    Article  PubMed  CAS  Google Scholar 

  22. Gould KL, Sorenson SG, Albro PC et al. (1986) Thallium-201 myocardial imaging during coronary vasodilation induced by oral dipyridamole. J Nucl Med 27:31–36

    PubMed  CAS  Google Scholar 

  23. Gould KL (1989) Coronary steal; is it clinically important? Chest 96:227–229

    Article  PubMed  CAS  Google Scholar 

  24. Gupta NC, Esterbrooks DJ, Hilleman DE, Mohiuddin SM for the GE SPECT Multicenter Adenosine Study Group (1992) Comparison of adenosine and exercise thallium-201 single-photon emission computed tomography (SPECT) myocardial perfusion imaging. J Am Coll Cardiol 19:248–257

    Article  PubMed  CAS  Google Scholar 

  25. Hammond HK, McKirnan MD (1992) Arbutamine is more effective than dobutamine as a diagnostic stress agent in a porcine model for myocardial ischemia (abstr.). Circulation 86 (Suppl. I): I–126

    Google Scholar 

  26. Hoffmann JIE (1984) Maximal coronary flow and the concept of coronary vascular reserve. Circulation 70:153–164

    Article  Google Scholar 

  27. Hoffmann R, Lethen H, Kleinhans E et al. (1991) Comparison of bicycle and dobutamine stress echocardiography for identification of coronary artery disease (abstr.). Circulation 84 (Suppl. II): II–476

    Google Scholar 

  28. Hoffmann R, Lethen H, Weiß M et al. (1993) Incremental value of exercise and dobutamine echocardiography in patients with normal exercise ECG compared with SPECT (abstr.). J Am Coll Cardiol 21:383 A

    Google Scholar 

  29. Jaarsma W, Sutherland G on behalf of the European Arbutamine Study Group (1992) Computerized closed loop delivery of arbutamine, a new agent for the diagnosis of coronary artery disease (abstr.). Circulation 86 (Suppl. I): I–126

    Google Scholar 

  30. Kaul S, Boucher CA, Newell JB et al. (1986) Determination of the quantitative thallium imaging variables that optimize detection of coronary artery disease. J Am Coll Cardiol 7:527–537

    Article  PubMed  CAS  Google Scholar 

  31. Kaul S, Finkelstein DM, Homma S et al. (1988) Superiority of quantitative exercise thallium-201 variables in determining long-term prognosis in ambulatory patients with chest pain: A comparison with cardiac catheterization. J Am Coll Cardiol 12:25–34

    Article  PubMed  CAS  Google Scholar 

  32. Lanzarini L, Feteveau R, Poli A et al. (1993) Comparison of dobutamine and dipyridamole stress-echo with exercise test for coronary artery disease diagnosis (abstr.) J Am Coll Cardiol 21:89 A.

    Google Scholar 

  33. Leier CV, Unverferth DV (1983) Dobutamine. Ann Intern Med 99:490–496

    PubMed  CAS  Google Scholar 

  34. Leppo JA (1989) Dipyridamole-thallium imaging: the lazy man’s stress test. J Nucl Med 30:281–287

    PubMed  CAS  Google Scholar 

  35. Mannering D, Cripps T, Leech G et al. (1988) The dobutamine stress test as an alternative to exercise testing after acute myocardial infarction. Br Heart J 59:521–526

    Article  PubMed  CAS  Google Scholar 

  36. Marcovitz PA, Armstrong WF (1991) Dobutamine stress echocardiography: diagnostic utility. Herz 16:372–378

    PubMed  CAS  Google Scholar 

  37. Marcovitz PA, Armstrong WF (1992) Accuracy of dobutamine stress echocardiography in detecting coronary artery disease. Am J Cardiol 69:1269–1273

    Article  PubMed  CAS  Google Scholar 

  38. Martin TW, Seaworth JF, Johns JP, Pupa LE, Condos WR (1992) Comparison of adenosine, dipyridamole and dobutamine in stress echocardiography. Ann Intern Med 116:190–196

    PubMed  CAS  Google Scholar 

  39. Marwick T, Willemart B, D’Hondt AM et al. (1993) Selection of the optimal nonexercise stress for the evaluation of ischemic regional myocardial dysfunction and malperfusion. Circulation 87:345–354

    PubMed  CAS  Google Scholar 

  40. Marwick TH, Nemec JJ, Pashkow FJ, Stewart WJ, Salcedo E (1992) Accuracy and limitations of exercise echocardiography in a routine clinical setting. J Am Coll Cardiol 19:74–81

    Article  PubMed  CAS  Google Scholar 

  41. Masini M, Picano E, Lattanzi F et al. (1988) High dose dipyridamole-echocardiography test in woman: correlation with exercise-electrocardiography test and coronary arteriography. J Am Coll Cardiol 12:682–685

    PubMed  CAS  Google Scholar 

  42. Mazeika P, Nihoyannopoulos P, Joshi J, Oakley CM (1992) Uses and limitations of high dose dipyridamole stress echocardiography for evaluation of coronary artery disease. Br Heart J 67:144–149

    Article  PubMed  CAS  Google Scholar 

  43. Mazeika PK, Nadazdin A, Oakley CM (1992) Dobutamine stress echocardiography for detection and assessment of coronary artery disease. J Am Coll Cardiol 19:1203–1211

    Article  PubMed  CAS  Google Scholar 

  44. McNeill AJ, Fioretti PM, El-Said EM et al. (1992) Enhanced sensitivity for detection of coronary artery disease by addition of atropine to dobutamine stress echocardiography. Am J Cardiol 70:41–46

    Article  PubMed  CAS  Google Scholar 

  45. Meerdink DJ, Okada RD, Leppo JA (1989) The effect of dipyridamole on transmural blood flow gradients. Chest 96:400–405

    Article  PubMed  CAS  Google Scholar 

  46. Mertes H, Sawada SG, Ryan T et al. (1992) Symptoms, side effects and complications during dobutamine stress echocardiography: experience in 1043 examinations (abstr.). Circulation 86 (Suppl. I): I–126

    Google Scholar 

  47. Nishimura S, Mahmarian JJ, Boyce TM, Verani MS (1992) Equivalence between adenosine and exercise thallium-201 myocardial tomography: a multicenter, prospective, crossover trial. J Am Coll Cardiol 20:265–275

    Article  PubMed  CAS  Google Scholar 

  48. Okada RD, Dai Y, Boucher CA et al. (1984) Serial thallium-201 imaging after dipyridamole for coronary disease detection: quantitative analysis using myocardial clearance. Am Heart J 107:475–480

    Article  PubMed  CAS  Google Scholar 

  49. Palac RT, Coombs BJ, Kudenchuk PJ et al. (1984) Two-dimensional echocardiography during dobutamine infusion: comparison with exercise testing in evaluation of coronary disease (abstr.). Circulation 70 (Suppl. II): II–184

    Google Scholar 

  50. Perin EC, Moore W, Blume M et al. (1991) Comparison of dipyridamole-echocardiography with dipyridamole-thallium scintigraphy for the diagnosis of myocardial ischemia. Clin Nucl Med 16:417–420

    Article  PubMed  CAS  Google Scholar 

  51. Picano E, Severi S, Michelassi C et al. (1989) Prognostic importance of dipyridamole-echocardiography test in coronary artery disease. Circulation 80:450–457

    Article  PubMed  CAS  Google Scholar 

  52. Picano E, Distante A, Masini M et al. (1985) Dipyridamole-echocardiography test in effort angina pectoris. Am J Cardiol 56:452–456

    Article  PubMed  CAS  Google Scholar 

  53. Picano E, Morales MA, Distante A et al. (1986) Dipyridamole-echocardiography test in angina at rest: non-invasive assessment of coronary stenosis underlying spasm. Am Heart J 111:688–691

    Article  PubMed  CAS  Google Scholar 

  54. Picano E, Marini C, Pirelli S et al. (1992) Safety of intravenous high-dose dipyridamole echocardiography. Am J Cardiol 70:252–258

    Article  PubMed  CAS  Google Scholar 

  55. Picano E, Lattanzi F, Masini M, Distante A, L’Abatte A (1986) High dose dipyridamole echocardiography test in effort angina pectoris. J Am Coll Cardiol 8:848–854

    Article  PubMed  CAS  Google Scholar 

  56. Pirelli S, Danzi GB, Alberti A et al. (1991) Comparison of usefullness of high-dose dipyridamole echocardiography and exercise electrocardiography for detection of asymptomatic restenosis after coronary angioplasty. Am J Cardiol 67:1335–1338

    Article  PubMed  CAS  Google Scholar 

  57. Previtali M, Lanzarini L, Ferrario M et al. (1991) Dobutamine versus dipyridamole echocardiography in coronary artery disease. Circulation 83 (Suppl. III): III-27–III-31

    CAS  Google Scholar 

  58. Ranhosky A, Kempthorne-Rawson J and the Intravenous Dipyridamole-Thallium Imaging Study Group (1990) The safety of intravenous dipyridamole thallium myocardial perfusion imaging. Circulation 81:1205–1209

    Article  PubMed  CAS  Google Scholar 

  59. Robertson WS, Feigenbaum H, Armstrong WF et al. (1983) Exercise echocardiography: a clinically practical addition in the evaluation of coronary artery disease. J Am Coll Cardiol 2:1085–1091

    Article  PubMed  CAS  Google Scholar 

  60. Rosamond TL, Vacek JL, Hurwitz A et al. (1992) Hypotension during dobutamine stress echocardiography: initial description and clinical relevance. Am Heart J 123:403–407

    Article  PubMed  CAS  Google Scholar 

  61. Rossen JD, Quillen JE, Lopez AG et al. (1991) Comparison of coronary vasodilation with intravenous dipyridamole and adenosine. J Am Coll Cardiol 18:485–491

    Article  PubMed  CAS  Google Scholar 

  62. Salustri A, Fioretti PM, Pozzoli MMA et al. (1992) Dobutamine stress echocardiography: its role in the diagnosis of coronary artery disease. Eur Heart J 13:70–77

    PubMed  CAS  Google Scholar 

  63. Sawada SG, Segar DS, Ryan T et al. (1991) Echocardiographic detection of coronary artery disease during dobutamine infusion. Circulation 83:1605–1614

    PubMed  CAS  Google Scholar 

  64. Segar DS, Brown SE, Sawada SG et al. (1992) Dobutamine stress echocardiography: correlation with coronary lesion severity as determined by quantitative angiography. J Am Coll Cardiol 19:1197–1202

    Article  PubMed  CAS  Google Scholar 

  65. Sonnenblick EH, Frishman WH, LeJemtel TH (1979) Dobutamine: a new synthetic cardioactive sympathetic amine. N Engl J Med 300:17–22

    Article  PubMed  CAS  Google Scholar 

  66. Strauss HW, Harrison K, Langen JK et al. (1975) Thallium 201 for myocardial imaging. Relation of thallium 201 to regional myocardial perfusion. Circulation 51:641–645

    PubMed  CAS  Google Scholar 

  67. Tuttle RR, Mills J (1975) Dobutamine: development of a new catecholamine to selectively increase cardiac contractility. Circ Res 36:185–196

    PubMed  CAS  Google Scholar 

  68. Van Train KF, Berman DS, Garcia EV et al. (1986) Quantitative analysis of stress thallium-201 myocardial scintigrams: A multicenter trial. J Nucl Med 27:17–25

    PubMed  Google Scholar 

  69. Vasu MA, O’Keefe DD, Kapellakis GZ et al. (1978) Myocardial oxygen consumption: effects of epinephrine, isoproterenol, dopamine, norepinephrine and dobutamine. Am J Physiol 235: H237–241

    PubMed  CAS  Google Scholar 

  70. Verani MS, Mahmarian JJ, Hixson JB, Boyce TM, Standacher RA (1990) Diagnosis of coronary artery disease by controlled coronary vasodilation with adenosine and thallium-201 scintigraphy in patients unable to exercise. Circulation 82:80–87

    Article  PubMed  CAS  Google Scholar 

  71. Wilson RF, Wyche K, Christensen BV, Zimmer S, Laxson DD (1990) Effects of adenosine on human coronary arterial circulation. Circulation 82:1595–1606

    Article  PubMed  CAS  Google Scholar 

  72. Zoghbi WA (1991) Use of adenosine echocardiography for diagnosis of coronary artery disease. Am Heart J 122:285–292

    Article  PubMed  CAS  Google Scholar 

  73. Zoghbi WA, Cheirif J, Kleiman NS, Verani MS, Trakhtenbroit A (1991) Diagnosis of ischemic heart disease with adenosine echocardiography. J Am Coll Cardiol 18:1271–1298

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Klinik I, Medizinische Einrichtung der Rheinisch-Westfälisch-Technischen Hochschule Aachen, Pauwelsstraße 30, Aachen, D-52074, Deutschland

    Dr. med. H. G. Klues, Y. Grafen, R. Hoffmann, F. A. Flachskampf & P. Hanrath

Authors
  1. Dr. med. H. G. Klues
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Y. Grafen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. A. Flachskampf
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Hanrath
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Klin. Abt. 1, Klinik Höhenried der LVA Oberbayern, Bernried/Obb, 82347, Deutschland

    J. Gehring

  2. I. Med. Klinik, Technischen Universität München, Ismaningerstr. 22, München, 81675, Deutschland

    Helene von Bibra

Rights and permissions

Reprints and permissions

Copyright information

© 1993 Dr. Dietrich Steinkopff Verlag, GmbH & Co. KG Darmstadt

About this chapter

Cite this chapter

Klues, H.G., Grafen, Y., Hoffmann, R., Flachskampf, F.A., Hanrath, P. (1993). Stellenwert der pharmakologischen Belastungsechokardiographie. In: Gehring, J., von Bibra, H. (eds) Echokardiographische Diagnostik bei koronarer Herzkrankheit. Steinkopff. https://doi.org/10.1007/978-3-642-97791-6_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-97791-6_9

  • Publisher Name: Steinkopff

  • Print ISBN: 978-3-7985-0948-1

  • Online ISBN: 978-3-642-97791-6

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation