Department of Cardiology, Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
College of Public Health Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska.
J Am Coll Cardiol. 2013 Jun 18;61(24):2446-2455. doi: 10.1016/j.jacc.2013.04.019. Epub 2013 May 2.
The study sought to prospectively compare patient outcome after stress real-time myocardial contrast echocardiography (RTMCE) versus conventional stress echo (CSE), where contrast is used to optimize wall motion (WM) analysis.
Myocardial perfusion imaging with RTMCE may improve the detection of coronary artery disease (CAD), and predict patient outcome.
Patients with intermediate to high pre-test probability referred for dobutamine or exercise stress echocardiography were prospectively randomized to either RTMCE or CSE. Definity contrast was used for CSE only when endocardial border delineation was inadequate (63% of studies). Studies were interpreted by either an experienced contrast reviewer (R1; n = 1257), or 4 Level 3 echocardiographers (R2) with basic contrast training (n = 806). Death, nonfatal myocardial infarction (MI), and revascularizations were recorded at follow-up.
Follow-up was available in 2,014 patients (median 2.6 years). Mean age was 59 ± 13 years (53% women). An abnormal RTMCE was more frequently observed than an abnormal CSE (p < 0.001), and more frequently resulted in revascularization (p = 0.004). Resting WM abnormalities were also more frequently seen with RTMCE (p < 0.01), and were an independent predictor of death/nonfatal MI (p = 0.005) for RTMCE, but not CSE. The predictive value of a positive study, whether with CSE or RTMCE, was significant for both R1 and R2 reviewers in predicting the combined endpoint, but R1 was better than R2 at predicting patients at risk for death or nonfatal MI.
Perfusion imaging with RTMCE improves the detection of CAD during stress echocardiography, and identifies those more likely to undergo revascularization following an abnormal study.
本研究旨在前瞻性比较实时心肌声学造影（RTMCE）与传统负荷超声心动图（CSE）的患者预后，其中造影剂用于优化壁运动（WM）分析。
RTMCE 心肌灌注成像可能提高冠状动脉疾病（CAD）的检出率，并预测患者预后。
对中间至高术前概率的患者进行多巴酚丁胺或运动负荷超声心动图检查，并前瞻性随机分为 RTMCE 或 CSE 组。仅当心内膜边界描绘不足时（63%的研究）才在 CSE 中使用 Definity 造影剂。研究由一位有经验的造影剂审查者（R1；n=1257）或 4 位接受过基本造影剂培训的 3 级超声心动图医师（R2；n=806）进行解读。随访记录死亡、非致死性心肌梗死（MI）和血运重建。
2014 例患者（中位数随访 2.6 年）有随访资料。平均年龄为 59±13 岁（53%为女性）。与 CSE 相比，RTMCE 异常更常见（p<0.001），且更常导致血运重建（p=0.004）。RTMCE 时也更常出现静息 WM 异常（p<0.01），且是 RTMCE 死亡/非致死性 MI 的独立预测因素（p=0.005），但 CSE 不是。无论是 CSE 还是 RTMCE，阳性研究的预测价值对 R1 和 R2 审查者预测复合终点均有意义，但 R1 预测死亡或非致死性 MI 风险患者的能力优于 R2。
RTMCE 灌注成像可提高负荷超声心动图检查中 CAD 的检出率，并识别出更可能在异常研究后进行血运重建的患者。
