Tsutsui Jeane M, Elhendy Abdou, Anderson James R, Xie Feng, McGrain Anna C, Porter Thomas R
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-1165, USA.
Circulation. 2005 Sep 6;112(10):1444-50. doi: 10.1161/CIRCULATIONAHA.105.537134. Epub 2005 Aug 29.
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.
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.
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.
实时对比增强超声心动图（RTCE）的心肌灌注（MP）成像提高了多巴酚丁胺负荷超声心动图检测冠状动脉疾病的敏感性。其预后价值尚不清楚。我们试图确定多巴酚丁胺负荷超声心动图期间MP和壁运动（WM）分析对已知或疑似冠状动脉疾病患者预后的预测价值。
我们回顾性研究了788例在多巴酚丁胺负荷超声心动图期间使用静脉注射商用造影剂进行RTCE的患者。通过对数似然检验（Cox模型）检验了MP成像相对于临床危险因素和其他超声心动图数据的增量预后价值。在中位随访20个月期间，发生了75起事件（9.6%）（58例死亡，17例非致命性心肌梗死）。在预测事件方面，异常MP相对于临床因素、静息射血分数和WM反应具有显著的增量价值（P<0.001）。通过多变量分析，死亡和非致命性心肌梗死的独立预测因素为静息左心室射血分数<50%（相对风险[RR]，1.9；95%CI，1.2至3.2；P=0.01）、高胆固醇血症（RR，0.5；95%CI，0.3至0.9；P=0.01）和异常MP（RR，5.2；95%CI，3.0至9.0；P<0.0001）。WM和MP正常的患者3年无事件生存率为95%，WM正常但MP异常的患者为82%，WM和MP均异常的患者为68%。
多巴酚丁胺负荷RTCE期间的MP成像为已知或疑似冠状动脉疾病患者提供了增量预后信息。MP正常的患者比WM正常的患者预后更好。
