Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, 69198-1165, USA.
Eur Heart J Cardiovasc Imaging. 2021 Apr 28;22(5):553-562. doi: 10.1093/ehjci/jeaa026.
To evaluate the prognostic value of myocardial perfusion (MP) imaging during contrast stress echocardiography (cSE) in patients with known or suspected coronary artery disease (CAD).
A search in PubMed, Embase databases, and the Cochrane library was conducted through May 2019. The Cochran Q statistic and the I2 statistic were used to assess heterogeneity, and the results were analysed by RevMan V5.3 and Stata V15.1 software. Twelve studies (seven dipyridamole and five exercise/dobutamine) without evidence of patient overlap (same institution publishing results over a similar time period) enrolling 5953 subjects (47% female, 8-80 months of follow-up) were included in the analysis. In all studies, total adverse cardiovascular events were defined as either cardiac death, non-fatal myocardial infarction (NFMI), or need for urgent revascularization. Hazard ratios (HRs) revealed that a MP abnormality [pooled HR 4.75; 95% confidence interval (CI) 2.47-9.14] was a higher independent predictor of total events than abnormal wall motion (WM, pooled HR 2.39; 95% CI 1.58-3.61) and resting left ventricular ejection fraction (LVEF, pooled HR 1.92; 95% CI 1.44-2.55) with significant subgroup differences (P = 0.002 compared with abnormal WM and 0.01 compared with abnormal LVEF). Abnormal MP was associated with higher risks for death [Risk ratio (RR) 5.24; 95% CI 2.91-9.43], NFMI (RR 3.09; 95% CI 1.84-5.21), and need for coronary revascularization (RR 16.44; 95% CI 6.14-43.99).
MP analysis during stress echocardiography is an effective prognostic tool in patients with known or suspected CAD and provides incremental value over LVEF and WM in predicting clinical outcomes.
评估对比负荷超声心动图（cSE）心肌灌注（MP）成像在已知或疑似冠心病（CAD）患者中的预后价值。
通过 2019 年 5 月在 PubMed、Embase 数据库和 Cochrane 图书馆进行检索。使用 Cochran Q 统计量和 I2 统计量评估异质性，并使用 RevMan V5.3 和 Stata V15.1 软件进行分析。共纳入 12 项研究（7 项双嘧达莫和 5 项运动/多巴酚丁胺），这些研究没有患者重叠的证据（同一机构在相似时间段内发表结果），共纳入 5953 例患者（47%为女性，随访时间 8-80 个月）。在所有研究中，总不良心血管事件定义为心脏死亡、非致死性心肌梗死（NFMI）或需要紧急血运重建。风险比（HR）显示，MP 异常（合并 HR 4.75；95%置信区间 [CI] 2.47-9.14）是总事件的更高独立预测因素，高于异常壁运动（WM，合并 HR 2.39；95%CI 1.58-3.61）和静息左心室射血分数（LVEF，合并 HR 1.92；95%CI 1.44-2.55），且亚组差异具有统计学意义（与异常 WM 相比，P=0.002；与异常 LVEF 相比，P=0.01）。MP 异常与死亡（风险比 [RR] 5.24；95%CI 2.91-9.43）、NFMI（RR 3.09；95%CI 1.84-5.21）和需要冠状动脉血运重建（RR 16.44；95%CI 6.14-43.99）的风险增加相关。
在已知或疑似 CAD 患者中，应激超声心动图时的 MP 分析是一种有效的预后工具，在预测临床结局方面比 LVEF 和 WM 提供了额外的价值。
