Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
J Am Soc Echocardiogr. 2013 May;26(5):539-47. doi: 10.1016/j.echo.2013.01.016. Epub 2013 Feb 26.
Quantification of myocardial blood flow reserve in patients with coronary artery disease using real-time myocardial perfusion echocardiography (RTMPE) has been demonstrated to further improve accuracy over the analysis of wall motion and qualitative analysis of myocardial perfusion. The aim of this study was to determine the prognostic value of qualitative and quantitative analyses obtained by RTMPE in patients with known or suspected coronary artery disease.
From March 2003 to December 2008, 227 consecutive patients with normal left ventricular function who underwent RTMPE were prospectively studied. Replenishment velocity reserve (β) and myocardial blood flow reserve were derived from RTMPE. Primary outcomes were cardiac death, myocardial infarction and unstable angina with need for urgent coronary revascularization, and secondary outcomes were coronary bypass graft surgery or angioplasty.
During a median follow-up period of 32 months (range, 5 days to 6.9 years), 19 major events (two deaths, six myocardial infarctions, and 11 episodes of unstable angina) and 46 total events occurred. Wall motion (hazard ratio [HR], 2.8; 95% confidence interval [CI], 1.4-5.6; P = .003) and qualitative myocardial perfusion analysis (HR, 4.3; 95% CI, 2.1-8.5; P < .001) were predictors of total events but not primary events. Abnormal myocardial blood flow reserve and abnormal β reserve were predictors of total events (HR, 8.1; 95% CI, 3-21; P < .001; and HR, 16.5; 95% CI, 5.5-49; P < .001) and primary events (HR, 3.8; 95% CI, 1-15; P = .048; and HR, 8.7; 95% CI, 1.8-40; P = .005). On multivariate analysis, only abnormal β reserve was an independent predictor of total (HR, 10.6; 95% CI, 2.5-43; P = .001) and primary (HR, 10.5; 95% CI, 1.5-6; P = .015) events. Abnormal β reserve added incremental value in predicting primary events (χ(2) = 2.0-13.2; P = .014).
Quantitative adenosine stress RTMPE added independent and additional prognostic information over wall motion and qualitative myocardial perfusion analysis in patients with known or suspected coronary artery disease and normal left ventricular function.
实时心肌灌注超声心动图（RTMPE）定量分析冠状动脉疾病患者的心肌血流储备，与节段性室壁运动分析和心肌灌注的定性分析相比，进一步提高了诊断的准确性。本研究旨在确定 RTMPE 获得的定性和定量分析在已知或疑似冠状动脉疾病患者中的预后价值。
2003 年 3 月至 2008 年 12 月，前瞻性研究了 227 例左心室功能正常且接受 RTMPE 的连续患者。通过 RTMPE 得出补充速度储备（β）和心肌血流储备。主要终点为心脏性死亡、心肌梗死和需要紧急冠状动脉血运重建的不稳定型心绞痛，次要终点为冠状动脉旁路移植术或经皮冠状动脉成形术。
在中位随访 32 个月（范围为 5 天至 6.9 年）期间，发生 19 例主要事件（2 例死亡，6 例心肌梗死和 11 例不稳定型心绞痛）和 46 例总事件。节段性室壁运动（危险比 [HR]，2.8；95%置信区间 [CI]，1.4-5.6；P=0.003）和定性心肌灌注分析（HR，4.3；95%CI，2.1-8.5；P<0.001）是总事件的预测因素，但不是主要事件的预测因素。异常的心肌血流储备和异常的β储备是总事件（HR，8.1；95%CI，3-21；P<0.001；HR，16.5；95%CI，5.5-49；P<0.001）和主要事件（HR，3.8；95%CI，1-15；P=0.048；HR，8.7；95%CI，1.8-40；P=0.005）的预测因素。多变量分析显示，仅异常的β储备是总事件（HR，10.6；95%CI，2.5-43；P=0.001）和主要事件（HR，10.5；95%CI，1.5-6；P=0.015）的独立预测因素。异常的β储备在预测主要事件方面增加了额外的价值（χ2=2.0-13.2；P=0.014）。
在已知或疑似冠状动脉疾病和左心室功能正常的患者中，腺苷负荷 RTMPE 的定量分析比节段性室壁运动分析和心肌灌注的定性分析提供了独立的、额外的预后信息。
