rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2011-7-6-744-751rpcardio-989Research ArticleNOTES FROM PRACTICEКЛИНИЧЕСКИЙ ОПЫТCURRENT APPROACHES TO EVALUATION OF THE MULTIVESSEL CORONARY ATHEROSCLEROSIS IN PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASEСОВРЕМЕННЫЕ ПОДХОДЫ К ОЦЕНКЕ МНОГОСОСУДИСТОГО ПОРАЖАЕНИЯ КОРОНАРНОГО РУСЛА У БОЛЬНЫХ ХРОНИЧЕСКОЙ ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦАПеруцкийД. Н.PerutskyD. N.

врач-кардиолог отделения реанимации и интенсивной терапии кардиологического профиля

d_perutsky@yahoo.comКоваленкоИ. Б.KovalenkoI. B.

к.м.н., заведующий отделением рентгенохирургических методов лечения

КонстантиновС. Л.KonstantinovS. L.

врач-кардиолог, заведующий отделением реанимации и интенсивной терапии кардиологического профиля

МакееваТ. И.MakeevaT. I.

д.м.н., профессор кафедры кардиологии

ФилатовМ. В.FilatovM. V.

врач-хирург отделения рентгенохирургических методов лечения

Белгородская областная клиническая больница Святителя ИоасафаРоссияSt. Joasaph' Belgorod Regional HospitalRussian FederationСанкт-Петербургская медицинская академия постдипломного образованияРоссияSt-Petersburg Medical Academy of Postgraduate StudiesRussian Federation20112301201676744751Copyright © Perutsky D.N., Kovalenko I.B., Konstantinov S.L., Makeeva T.I., Filatov M.V., 20162016Перуцкий Д.Н., Коваленко И.Б., Константинов С.Л., Макеева Т.И., Филатов М.В.Perutsky D.N., Kovalenko I.B., Konstantinov S.L., Makeeva T.I., Filatov M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/989

Aim. To determine the validity of stress echocardiography by fractional reserve blood flow (FFR) as the reference method in detection of coronary arteries requiring revascularization, as well as to optimize the determination of the functional significance of coronary artery lesions in patients with multivessel coronary atherosclerosis. Material and methods. Patients (n=36) with stable angina class 2-3 with multivessel coronary atherosclerosis were included into the study. Stress echocardiography with dobutamine or exercise test (treadmill) was performed in all patients. Selective coronary angiography with subsequent evaluation of FFR was carried out in patients with a positive result of stress echocardiography. Totally 108 arteries (87 with stenosing atherosclerosis) were assessed.  Results. According to coronary angiography bi-vessel and three-vessel damages were revealed in 21 (58%) and 15 (42%) patients, respectively. Method of stress echocardiography as compared with FFR shown sensitivity — 58%, specificity — 95%, positive predictive value — 87%, positive predictive value of a negative result — 17%. Method of coronary angiography (as a method to detect significant stenosis by visual assessment of coronary artery) as compared with FFR demonstrated sensitivity 100%, specificity — 30%, positive predictive value — 42%. Conclusion. Stress echocardiography for noninvasive patient examination improves the accuracy of determination for the need and extent of revascularization.

Цель. Определить достоверность стресс-эхокардиографии (ЭХОКГ) с помощью фракционного резерва кровотока (ФРК) как референтного метода в выявлении коронарных сосудов, требующих реваскуляризации. Оптимизировать определение функциональной значимости поражения коронарных артерий у больных ишемической болезнью сердца с многососудистым типом поражения коронарного русла. Материал и методы. 36 больных стабильной стенокардией 2-3 функционального класса с многососудистым типом поражения коронарного русла были включены в исследование. Всем больным была проведена стресс-ЭХОКГ с добутамином или с физической нагрузкой (тредмил). При положительном результате стресс-ЭХОКГ проводили селективную коронароангиографию (КАГ) с последующим определением ФРК. Всего была проведена оценка 108 магистральных артерий, из них 87 со стенозирующим атеросклерозом. Результаты. Двусосудистое поражение по данным КАГ зарегистрировано у 21 (58%) больных, трехсосудистое — у 15 (42%). Метод стресс-ЭХОКГ при сопоставлении с ФРК имел чувствительность 58%, специфичность - 95%, прогностическая ценность положительного результата составила 87%, прогностическая ценность отрицательного результата 17%. При оценке КАГ (как метода для выявления значимых стенозов посредством визуальной оценки стенозирования коронарного русла) с помощью ФРК чувствительность составила 100%, специфичность 30%, прогностическая ценность положительного результата 42%. Заключение. Стресс-ЭХОКГ на этапе неинвазивного обследования пациентов позволяет повысить точность определения необходимости и объема проведения реваскуляризации.

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The authors declare that there are no conflicts of interest present.