Department of Cardiology, Parma University Hospital, Parma, Italy.
J Am Soc Echocardiogr. 2011 Dec;24(12):1333-41. doi: 10.1016/j.echo.2011.09.002. Epub 2011 Oct 19.
No large study has demonstrated that any stress test can risk-stratify future hard cardiac events (cardiac death or myocardial infarction) in patients with suspected acute coronary syndromes (ACS), nondiagnostic electrocardiographic (ECG) findings, and normal troponin levels. The aim of this study was to test the hypothesis that combined contrast wall motion and myocardial perfusion echocardiographic assessment (cMCE) during stress echocardiography can predict long-term hard cardiac events in patients with suspected ACS, nondiagnostic ECG findings, and normal troponin.
A total of 545 patients referred for contrast stress echocardiography from the emergency department for suspected ACS but nondiagnostic ECG findings and normal troponin levels at 12 hours were followed up for cardiac events. Patients underwent dipyridamole-atropine echocardiography with adjunctive myocardial perfusion imaging using a commercially available ultrasound contrast medium (SonoVue).
During a median follow-up period of 12 months, 25 cardiac events (4.6%) occurred (no deaths, 12 nonfatal myocardial infarctions, 13 episodes of unstable angina). Abnormal findings on cMCE were the most significant predictor of both hard cardiac events (hazard ratio, 22.8; 95% confidence interval, 2.9-176.7) and the combined (cardiac death, myocardial infarction, or unstable angina requiring revascularization) end point (hazard ratio, 10.7; 95% confidence interval, 3.7-31.3). The inclusion of the cMCE variable significantly improved multivariate models, determining lower Akaike information criterion values and higher discrimination ability.
cMCE during contrast stress echocardiography provided independent information for predicting hard and combined cardiac events beyond that predicted by stress wall motion abnormalities in patients with suspected ACS, nondiagnostic ECG findings, and normal troponin levels.
没有大型研究表明，任何压力测试都可以对疑似急性冠脉综合征（ACS）、心电图（ECG）检查结果不明确且肌钙蛋白水平正常的患者进行未来严重心脏事件（心脏死亡或心肌梗死）的风险分层。本研究旨在检验以下假设，即应激超声心动图时联合对比壁运动和心肌灌注超声心动图评估（cMCE）可预测疑似 ACS、心电图检查结果不明确且肌钙蛋白正常的患者的长期严重心脏事件。
共有 545 例因疑似 ACS 而从急诊科转至我院行对比应激超声心动图检查，但心电图检查结果不明确且肌钙蛋白水平在 12 小时内正常的患者进行了随访，以观察心脏事件的发生情况。患者接受双嘧达莫-阿托品超声心动图检查，同时使用市售超声对比剂（声诺维）进行心肌灌注成像。
在中位随访 12 个月期间，25 例患者发生了心脏事件（无死亡，12 例非致命性心肌梗死，13 例不稳定型心绞痛）。cMCE 异常是严重心脏事件（危险比，22.8；95%置信区间，2.9-176.7）和复合终点（心脏死亡、心肌梗死或需要血运重建的不稳定型心绞痛）的最强预测因子（危险比，10.7；95%置信区间，3.7-31.3）。cMCE 变量的纳入显著改善了多变量模型，确定了更低的赤池信息量准则值和更高的判别能力。
在疑似 ACS、心电图检查结果不明确且肌钙蛋白水平正常的患者中，对比应激超声心动图时的 cMCE 提供了独立于应激壁运动异常之外的预测严重和复合心脏事件的信息。
