Prognostic Value of High-Dose Dipyridamole Stress Myocardial Contrast Perfusion Echocardiography
Background—The addition of myocardial perfusion (MP) imaging during dipyridamole real-time contrast echocardiography (DipRCE) improves the sensitivity to detect coronary artery disease, but its prognostic value to predict hard cardiac events in large numbers of patients with known or suspected coronary artery disease remains unknown.
Methods and Results—We studied 1252 patients with DipRCE and followed them for a median of 25 months. The prognostic value of MP imaging regarding death and nonfatal myocardial infarction was determined and related to wall motion (WM), clinical risk factors and rest ejection fraction using Cox proportional-hazards models, C index and risk reclassification analysis. A total of 59 hard events (4.7%) occurred during the follow up (24 deaths, 35 myocardial infarctions). The 2-year event-free survival was 97.9% in patients with normal MP and WM, 91.9% with isolated reversible MP defects but normal WM, and 67.4% with both reversible MP and WM abnormalities (p<0.001). By multivariate analysis the independent predictors of events were age (HR 1.05, 95% CI 1.02-1.08), gender (HR 2.36, 95% CI 1.32-4.23), reversible MP defects (HR 3.88, 95% CI 1.83-8.21) and reversible WM abnormalities with reversible MP defects (HR 4.51, 95% CI 2.25-9.07). Reversible MP defects added incremental predictive value and reclassification benefit over WM response and clinical factors (p=0.001).
Conclusions—MP imaging using real time perfusion echocardiography during DipRCE provides independent, incremental prognostic information regarding hard cardiac events in patients with known or suspected coronary artery disease. Patients with normal MP responses have better outcome than patients with normal WM; patients with both reversible WM and MP abnormalities have the worst outcome.
- coronary artery disease
- myocardial contrast echocardiography
- stress echocardiography
- Received April 6, 2012.
- Accepted July 5, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited