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題 名 | Safety and Predictors of a Positive Result of Intracoronary Ergonovine Testing in Patients with Ischemic Heart Disease without Hemodynamically Significant Coronary Artery Stenosis in Taiwan=臺灣地區無冠狀動脈血行動力學有意義狹窄的缺血性心臟病患其冠狀動脈內給予麥角新素的安全性和陽性反應預測因子之研究 |
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作 者 | 洪明佑; 洪明銳; 鄭淇文; 楊甯貽; 程文俊; | 書刊名 | Acta Cardiologica Sinica |
卷 期 | 23:3 2007.09[民96.09] |
頁 次 | 頁150-159 |
分類號 | 415.3161 |
關鍵詞 | 麥角新素; 冠狀動脈痙攣; 心室顫動; Ergonovine; Coronary vasospasm; Ventricular fibrillation; |
語 文 | 英文(English) |
中文摘要 | 背景:在台灣地區,冠狀動脈內給予麥角新素之診斷檢查對冠狀動脈無血行動力學有意義狹窄的缺血性心臟病患其安全性和陽性反應預測因子尚未有研究資料。 方法:從2000年1月到2004年12月因疑似缺血性心臟病而接受心導管檢查的病患,若冠狀動脈血管攝影顯示無血行動力學有意義狹窄,則接著以冠狀動脈內給予劑量逐步漸增的麥角新素做冠狀動脈痙攣的檢查。冠狀動脈痙攣的定義為冠狀動脈內給予麥角新素後,冠狀動脈直徑減少超過 70%,並合併有胸悶或心電圖 ST段下降或上升的變化。 結果:總共有454位病人進入研究分析,對照組為193位病人其冠狀動脈無血行動力學有意義狹窄且沒有冠狀動脈痙攣,冠狀動脈痙攣組為261位病人無血行動力學有意義狹窄,但有冠狀動脈痙攣。麥角新素誘發冠狀動脈痙攣的比例為57%。有冠狀動脈痙攣的病人有較高的比例年長者,男性,抽煙且身體質量指數較低。最顯著的冠狀動脈痙攣預測因子是抽煙 (危險度2.796,p < 0.001)。冠狀動脈痙攣攝影檢查沒有造成心肌梗塞或死亡。有3位病人檢查中發生心室顫動 (0.66%),其中2位需要心臟電擊,另 1 位則是自行恢復正常心跳,但都無後遺症。 結論:對診斷冠狀動脈痙攣而言,冠狀動脈內給予麥角新素不是危險的侵入性檢查。抽煙是最顯著的冠狀動脈痙攣預測因子。 |
英文摘要 | Background: No information is available regarding the safety of intracoronary ergonovine provocation testing and the associated predictors in patients with suspected ischemic heart disease without hemodynamically significant coronary artery stenosis (CAS) in Taiwan. Methods: Patients who underwent cardiac catheterization for suspected ischemic heart disease and were found to have no hemodynamically significant CAS between January 2000 and December 2004 were enrolled. Provocation testing for coronary vasospasm was undertaken by administering a step-wise dose of intracoronary ergonovine. Coronary vasospasm was defined as a reduction in luminal diameter 70% during the provocation testing which was associated with angina and/or ST-depressive or elevated changes. Results: A total of 454 patients, including 193 with no hemodynamically significant CAS and no coronary vasospasm (control group) and 261 with coronary vasospasm without hemodynamically significant CAS (vasospasm group), were included in the analysis. The incidence of provoked coronary vasospasm was 57%. Patients with coronary vasospasm were more likely to be older, men, current smokers and to have a lower body mass index. The most significant independent predictor of coronary vasospasm was current smoker (odds ratio: 2.796, p < 0.001). No myocardial infarction or death was noted during intracoronary ergonovine testing. Ventricular fibrillation occurred during provocation testing in 3 patients (0.66%), of whom 2 required electric cardioversion and 1 had spontaneous recovery without sequelae. Conclusion: Intracoronary ergonovine provocation testing was not a risky intervention procedure for the diagnosis of coronary vasospasm. Current smoking was the most significant independent predictor of coronary vasospasm. |
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