Prognostic Value of Dobutamine Stress Myocardial Contrast Perfusion Echocardiography

Abstract

Background-Myocardial perfusion (MP) imaging with real-time contrast echocardiography (RTCE) improves the sensitivity of dobutamine stress echocardiography for detecting coronary artery disease. Its prognostic value is unknown. We sought to determine the value of MP and wall motion (WM) analysis during dobutamine stress echocardiography in predicting the outcome of patients with known or suspected coronary artery disease. Methods and Results-We retrospectively studied 788 patients with RTCE during dobutamine stress echocardiography using intravenous commercially available contrast agents. The incremental prognostic value of MP imaging over clinical risk factors and other echocardiographic data was examined through the use of a log-likelihood test (Cox model). During a median follow-up of 20 months, 75 events (9.6%) occurred (58 deaths, 17 nonfatal myocardial infarctions). Abnormal MP had significant incremental value over clinical factors, resting ejection fraction, and WM responses in predicting events (PϽ0.001). By multivariate analysis, the independent predictors of death and nonfatal myocardial infarction were resting left ventricular ejection fraction Ͻ50% (relative risk [RR], 1.9; 95% CI, 1.2 to 3.2; Pϭ0.01), hypercholesterolemia (RR, 0.5; 95% CI, 0.3 to 0.9; Pϭ0.01), and abnormal MP (RR, 5.2; 95% CI, 3.0 to 9.0; PϽ0.0001). The 3-year event free survival was 95% for patients with normal WM and MP, 82% for normal WM and abnormal MP, and 68% for abnormal WM and MP. Conclusion-MP imaging during dobutamine stress RTCE provides incremental prognostic information in patients with known or suspected coronary artery disease. Patients with normal MP have a better outcome than patients with normal WM.

The Role of Cardiac Ultrasound in Stem Cell Therapy

“…The classic manifestation of viability by dobutamine stress testing is the "biphasic response" whereby dyssyngeric myocardium shows enhanced contractility at low doses and then clear deterioration as ischemia appears at higher doses of the agent. Intravenous contrast agents to improve endocardial visualization have been shown to further improve the accuracy of viability assessment by ultrasound [29]. Myocardial viability can also be evaluated using contrast echocardiography to determine the transmural extent of infarction, which has been shown to agree with similar measurements by MRI [31].…”

“…Reduced ultrasonic signal intensity (defect) by this technique has been shown to be relatively sensitive and specific for the detection of ischemia [27] and can quantify infarct size and area at risk associated with ischemia [28]. In addition, contrast ultrasound assessment of perfusion has been shown to have additional prognostic value in patients undergoing stress testing [29]. Hence, this technique may be of use in selecting patients for treatment and following the effect of stem cell therapy upon myocardial perfusion.…”

Effect of Coronary Revascularization on the Prognostic Value of Stress Myocardial Contrast Wall Motion and Perfusion Imaging

“…Contrast stress echocardiography with additional myocardial perfusion assessment (cSE‐WMP) has demonstrated further increase in predictive accuracy for hard cardiac events in patients with suspected or known CAD, either during dobutamine10, 11 or vasodilator12, 13, 14 stress. As far as WM assessment is concerned, cSE‐WMP also has the advantage of maximizing test feasibility over standard stress echocardiography, with quality of acoustic windows not representing an issue when taking advantage of ultrasound contrast media 15.…”

“…Still, the few studies assessing cSE‐WMP for prognosis do not address its value specifically in predicting true ischemic events (cardiac death and nonfatal acute myocardial infarction [MI]),10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 and it is not known how the use of cSE‐WMP as a gatekeeper to coronary angiography and subsequent revascularization does relate to long‐term outcome in subsequently revascularized and nonrevascularized patients. Previous cSE‐WMP studies reported only on combined end points with prevalence of all‐cause deaths, half of them represented by cancer deaths, pneumonia, or other diseases that may not be directly influenced by coronary ischemia at stress testing 10, 11, 12, 13, 14. Cardiac ischemic events are instead clinically relevant end points, currently modifiable by timely aggressive medical or surgical therapy, if highest‐risk subjects can be identified 21.…”

Uso da ecocardiografia contrastada para avaliação de tumores e trombos

“…The use of contrast echocardiography has additionally show value in detecting alteration inventricular global function as well as in determining changes in segmental mobility and of myocardial perfusion both at rest and stress [3][4][5] . Currently, the validity of this method for differential diagnosis of cardiac masses is argued based on their vascular pattern analysis 6,7 .…”