Prognostic Value of Dobutamine Stress Myocardial Contrast Perfusion Echocardiography

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 (P<0.001). By multivariate analysis, the independent predictors of death and nonfatal myocardial infarction were resting left ventricular ejection fraction <50% (relative risk [RR], 1.9; 95% CI, 1.2 to 3.2; P=0.01), hypercholesterolemia (RR, 0.5; 95% CI, 0.3 to 0.9; P=0.01), and abnormal MP (RR, 5.2; 95% CI, 3.0 to 9.0; P<0.0001). 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.

[1]  V. Mor-Avi,et al.  Detection of regional temporal abnormalities in left ventricular function during acute myocardial ischemia. , 2001, American journal of physiology. Heart and circulatory physiology.

[2]  I. R. Thomson,et al.  Improved cardiac risk stratification in major vascular surgery with dobutamine-atropine stress echocardiography. , 1995, Journal of the American College of Cardiology.

[3]  N. Reichek,et al.  Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. , 1989, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[4]  T. Porter,et al.  Real-time perfusion imaging with low mechanical index pulse inversion Doppler imaging. , 2001, Journal of the American College of Cardiology.

[5]  S. Kaul,et al.  Perfusion Versus Function: The Ischemic Cascade in Demand Ischemia: Implications of Single-Vessel Versus Multivessel Stenosis , 2002, Circulation.

[6]  A Garfinkel,et al.  Prognostic value of dobutamine stress echocardiography in predicting cardiac events in patients with known or suspected coronary artery disease. , 1999, Journal of the American College of Cardiology.

[7]  Harald Becher,et al.  Assessment of systolic left ventricular function: a multi-centre comparison of cineventriculography, cardiac magnetic resonance imaging, unenhanced and contrast-enhanced echocardiography. , 2005, European heart journal.

[8]  J G Miller,et al.  Contrast Echocardiography: Current and Future Applications , 2000 .

[9]  A R Jayaweera,et al.  Coronary and myocardial blood volumes: noninvasive tools to assess the coronary microcirculation? , 1997, Circulation.

[10]  M. Lauer,et al.  Prediction of mortality using dobutamine echocardiography. , 2001, Journal of the American College of Cardiology.

[11]  Jeroen J. Bax,et al.  Long-term prognosis after normal dobutamine stress echocardiography. , 2003, The American journal of cardiology.

[12]  S. Kaul,et al.  Detection of coronary artery disease with myocardial contrast echocardiography: comparison with 99mTc-sestamibi single-photon emission computed tomography. , 1997, Circulation.

[13]  M. Cerqueira,et al.  Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. , 2002, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[14]  M. Vannan,et al.  Imaging technologies and techniques. , 2004, Cardiology clinics.

[15]  F. T. ten Cate,et al.  Assessment of systolic left ventricular function: a multi-centre comparison of cineventriculography, cardiac magnetic resonance imaging, unenhanced and contrast-enhanced echocardiography. , 2005, European Heart Journal.

[16]  P. Hartigan,et al.  Evaluation of exercise thallium scintigraphy versus exercise electrocardiography in predicting survival outcomes and morbid cardiac events in patients with single- and double-vessel disease. Findings from the Angioplasty Compared to Medicine (ACME) Study. , 1997, Journal of the American College of Cardiology.

[17]  Jeroen J. Bax,et al.  Prognostic value of dobutamine-atropine stress (99m)Tc-tetrofosmin myocardial perfusion SPECT in patients with known or suspected coronary artery disease. , 2002, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[18]  Jeroen J. Bax,et al.  Seven-year follow-up after dobutamine stress echocardiography: impact of gender on prognosis. , 2005, Journal of the American College of Cardiology.

[19]  M. Cerqueira,et al.  Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association , 2002, The international journal of cardiovascular imaging.

[20]  Value of negative dobutamine stress echocardiography in predicting long-term cardiac events. , 1999, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[21]  E. Picano,et al.  Safety and tolerability of dobutamine-atropine stress echocardiography: a prospective, multicentre study , 1994, The Lancet.

[22]  Jeroen J. Bax,et al.  Prognostic value of dobutamine stress echocardiography in patients with previous coronary revascularisation , 2004, Heart.

[23]  E. Picano,et al.  Safety and tolerability of dobutamine-atropine stress echocardiography: a prospective, multicentre study. Echo Dobutamine International Cooperative Study Group. , 1994, Lancet.

[24]  Jeroen J. Bax,et al.  Prediction of cardiac death in hypertensive patients with suspected or known coronary artery disease by stress technetium-99m tetrofosmin myocardial perfusion imaging , 2003, Journal of hypertension.

[25]  A R Jayaweera,et al.  Quantification of myocardial blood flow with ultrasound-induced destruction of microbubbles administered as a constant venous infusion. , 1998, Circulation.

[26]  D. Berman,et al.  Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification. , 1996, Circulation.

[27]  J. Seward,et al.  Role of dobutamine stress echocardiography in predicting outcome in 860 patients with known or suspected coronary artery disease. , 1998, Circulation.

[28]  S. Kaul,et al.  Independent and Incremental Prognostic Value of Tests Performed in Hierarchical Order to Evaluate Patients With Suspected Coronary Artery Disease: Validation of Models Based on These Tests , 1992, Circulation.

[29]  I. Kronzon,et al.  Long-term prognostic significance of dobutamine echocardiography in patients with suspected coronary artery disease: results of a 5-year follow-up study. , 1997, Journal of the American College of Cardiology.

[30]  Jeroen J. Bax,et al.  Long-term prognostic value of dobutamine stress echocardiography compared with myocardial perfusion scanning in patients unable to perform exercise tests. , 2004, The American journal of medicine.

[31]  James R. Anderson,et al.  Comparative accuracy of real-time myocardial contrast perfusion imaging and wall motion analysis during dobutamine stress echocardiography for the diagnosis of coronary artery disease. , 2004, Journal of the American College of Cardiology.

[32]  Jeroen J. Bax,et al.  Prognostic value of dobutamine stress echocardiography in patients with systemic hypertension and known or suspected coronary artery disease. , 2004, The American journal of cardiology.

[33]  F. Harrell,et al.  Prognostic value of dobutamine stress technetium-99m-sestamibi single-photon emission computed tomography myocardial perfusion imaging: stratification of a high-risk population. , 2001, Journal of the American College of Cardiology.

[34]  Jeroen J. Bax,et al.  Prognostic value of dobutamine stress echocardiography in patients with normal left ventricular systolic function. , 2004, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[35]  R M Peshock,et al.  Administration of an intravenous perfluorocarbon contrast agent improves echocardiographic determination of left ventricular volumes and ejection fraction: comparison with cine magnetic resonance imaging. , 1998, Journal of the American College of Cardiology.

[36]  L Crouse,et al.  Stress echocardiography: recommendations for performance and interpretation of stress echocardiography. Stress Echocardiography Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. , 1998, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[37]  G. Hillis,et al.  Comparison of intravenous myocardial contrast echocardiography and low-dose dobutamine echocardiography for predicting left ventricular functional recovery following acute myocardial infarction. , 2003, The American journal of cardiology.

[38]  M. Verani,et al.  Real-time assessment of myocardial perfusion and wall motion during bicycle and treadmill exercise echocardiography: comparison with single photon emission computed tomography. , 2001, Journal of the American College of Cardiology.

[39]  D. Levy,et al.  Prediction of coronary heart disease using risk factor categories. , 1998, Circulation.

[40]  A. Pasquet,et al.  Assessment of the physiologic significance of coronary disease with dipyridamole real-time myocardial contrast echocardiography. Comparison with technetium-99m sestamibi single-photon emission computed tomography and quantitative coronary angiography. , 2004, Journal of the American College of Cardiology.

[41]  S. Wilansky,et al.  Long-term prognosis in women with normal dobutamine stress echocardiography. , 1999, The American journal of cardiology.