Abstract 14718: Dual Imaging Stress Echocardiography versus Computed Tomography Coronary Angiography for Risk Stratification of Patients with Chest Pain of Unknown Origin
Background: Dual imaging stress echo, combining the evaluation ofwall motion and coronary flow reserve (CFR) on the left anterior descending artery (LAD), and computed tomography coronary angiography (CTCA) are established modalities to assess prognosis in chest pain patients. In this study we compared the prognostic value of the two techniques in a cohort of patients with chest pain having suspected coronary artery disease (CAD).
Methods: 131 patients (76 men; age 68±9 years) with chest pain of unknown origin underwent dipyridamole (up to 0.84 mg/kg over 6') stress echo with CFR assessment of LAD by Doppler and CTCA. A CFR ≤1.9 was considered abnormal, while >50% lumen diameter reduction was the criterion for significant CAD at CTCA .
Results: Of 131 patients, 34 (26%) had ischemia at stress echo by wall motion criteria, and 56 (43%) had impaired CFR. Significant CAD at CTCA was found in 58 (44%) subjects. Forty-four (79%) patients with abnormal CFR on LAD had significant CAD at CTCA (p<0.001). In addition, calcium score was higher in patients with reduced CFR than in those with normal CFR (265±404 vs 131±336, p=0.04). During a median follow-up of 9 months, 18 events (4 deaths, 14 myocardial infarctions) occurred. The event-free survival was markedly better for patients with preserved CFR and no stress-induced ischemia than in patients with abnormal CFR and/or stress-induced ischemia (Log Rank: 6.82, p<0.009, Figure). However, the event-free survival showed no significant difference in patients with and without significant CAD at CTCA (Log Rank: 1.43, p=0.23, Figure).
Conclusions: Dual imaging stress echocardiography provides superior prognostic capability as compared to CTCA in patients with chest pain and suspected CAD.
- © 2012 by American Heart Association, Inc.