Abstract 19197: Ischaemic Burden Determined by Myocardial Contrast Echocardiography Predicts Mortality in Patients with New-Onset Heart Failure
Objectives: In new onset heart failure, determination of ischaemic burden has therapeutic and prognostic implications. However the prognostic value of myocardial ischaemia determined by myocardial contrast echocardiography (MCE), a relatively new method of assessing myocardial perfusion, is unknown in such patients.
Methods: Accordingly 102 two patients (age: 66±11 years, 61% male) with heart failure (LVEF: 36±13%) underwent low power intermittent MCE (SonoVue 78%, Optison 22%) at rest and 2 minutes after dipyridamole infusion. Myocardial perfusion was assessed using a semi quantitative scoring system (2 - homogenous opacification, 1- reduced or heterogeneous opacification, and 0 - minimal or absent contrast opacification). Resting and stress perfusion score index (RPSI and SPSI) were calculated by averaging the scores in all 16 segments. Ischaemic burden (IB) was calculated by deducting RPSI from SPSI. All patients underwent coronary arteriography. Patients were followed-up for mortality.
Results: Of the 102 patients, 39 (38%) patients had CAD (presence of >50% luminal diameter narrowing of ≥1 major epicardial arteries or major branches). There were 29 (28%) deaths during a mean follow up of 60±29 months. Cox regression analysis showed that type 2 diabetes (p = 0.02, HR 2.41), presence of CAD (p = 0.01, HR 2.58) and IB (p = < 0.001 HR 0.23) were univariate predictors of mortality. Multivariate analysis showed that type 2 diabetes (p = 0.04) and IB (p = 0.003) were the only independent predictors of mortality. An IB = −0.06 predicted mortality of 44 % versus 20 % (p = 0.007) when IB ≤ −0.06. Kaplan Meier survival analysis is as shown.
Conclusion: Ischaemic burden determined by MCE is a powerful predictor of mortality in patients with new onset heart failure.
- © 2010 by American Heart Association, Inc.