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.
Compression volumes oscillometry allows to measure different parameters of the central and peripheral blood circulation. For an estimation of accuracy of this method in definition of linear and volume indicators of a system hemodynamics, as referential technology, the expert doppler-echocardiography was applied. The method has shown acceptable accuracy in measurement of stroke volume (±15 %), with consistent displacement (±1,96 standard deviations) at an estimation of dependence of a difference of measurements in two ways in Bland — Altman plot. The high correlation has been revealed between oscillometric peak speed in a humeral artery and doppler peak speed in aorta (р < 0,001; r = 0,85). Similar correlation was observed between aortic Doppler- spectrum integral and the peak speed of an arterial blood-groove (р < 0,001; r = 0,68).
Allocation of three levels of an echocardiography with corresponding levels of algorithms for optimum integration into multilevel diagnostic process is offered. Express, clinical and expert division corresponds to preventive, standard medical-diagnostic and highly technological directions of public health services. Three-level gradation should not cause decrease in its quality at the expense of the differentiated direction of conditionally healthy faces — on screening, the diseased — on clinical, cardiological patients — on expert ultrasonic cardiac diagnostics.
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