Abstract 2345: Does Myocardial Perfusion Imaging During Dobutamine Stress Echocardiography Provides Incremental Prognostic Information In Women With Suspected Coronary Artery Disease?
Background: The feasibility and acuracy of myocardial perfusion with real time contrast (RMP) echo during Dobutamine Stress Echocardiography(DSE) have been previously demonstrated. However, prognostic value of real time myocardial perfusion especially in women has not been studied. We therefore aimed to determine value of real time perfusion during DSE in predicting the outcome of female patients with suspected coronary artery disease.
Methods: We studied 182 women with real time perfusion imaging during DSE. All studies were interpreted and analyzed with respect to wall motion and myocardial perfusion. Study end points are death from any cause and non fatal myocardial perfusion. Cox regression analysis model is used to determine the incremental value of RMP over clinical ejection fraction(EF) and wall motion(WM).
Results: Within the follow up period of 24 months, 11 (6%) events occured. By univariate analysis, previous CABG, previous myocardial infarct, resting EF<50,abnormal WM and impaired RMP were event predictors. By multivariate analysis, EF<50% (RR,2.1; 95% CI,1.4 TO 3.4) and abnormal RMP (RR,6.2; 95% CI, 4.1 TO 10.1) were independent predictors of death and nonfatal myocardial infarction. By Cox regression model, the presence of EF<50 increased the risk of poor outcome over the other clinical and risk factors(x2=10.2; p<0.05). The xs2 has been increased by 9.1 with abnormality based on WM over clinical and risk factors and EF<50( X2=19.3; P<0.001). Abnormal RMP has increased the x2 additonal 16.4 over clinical, EF<50, and WM (X2=26.6; P<0.001) and added significant incremental value in predicting outcome.
Conclusions: Real time myocardial perfusion provides an incremental prognostic information in the prediction of nonfatal myocardial infarct and mortality in women with suspected coronary artery disease over clinical data, risk factors, ejection fraction and wall motion. A normal real time myocardial perfusion is associated with better outcome compared to normal wall motion in women.