Qian Lijun, Xie Feng, Xu Di, Porter Thomas R
Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Echo Res Pract. 2020 Sep;7(3):19-28. doi: 10.1530/ERP-20-0023. Epub 2020 Sep 1.
Resting myocardial perfusion (MP) and wall motion (WM) imaging during real-time myocardial contrast echocardiography (MCE) improves the detection of coronary artery disease (CAD). However, its prognostic role in different clinical settings (emergency department and outpatient setting) remains unclear.
A systematic search in PubMed and Embase databases, and the Cochrane library, was conducted to evaluate the role of resting MP and WM in predicting major adverse cardiac events (MACE), including death, nonfatal myocardial infarction (NFMI) and urgent revascularization in patients presenting to either outpatient clinics or emergency departments with suspected symptomatic CAD. Summary receiver operating characteristic (SROC) curves, sensitivity and specificity plots were applied to assess diagnostic performance using RevMan 5.3.
Seven studies met criteria, including 3668 patients (six with follow up ranging from 2 days to 2.6 years). The Relative Risk (RR) for predicting MACE in patients with both abnormal resting MP and WM was 6.1 (95% CI, 5.1-7.2) and 14.3 (95% CI, 10.3-19.8) for death/NFMI, when compared to normal resting MP and WM patients. Having both abnormal resting MP and WM was also more predictive of MACE (RR, 1.7; 95% CI 1.5-1.9) and death/NFMI (RR, 2.2; 95% CI, 1.8-2.7) when compared to abnormal WM with normal resting MP.
In this meta-analysis of both ED and outpatient clinic presentations for suspected CAD, having both a resting regional MP and WM abnormality identifies the highest risk patient for adverse events.
实时心肌对比超声心动图（MCE）期间的静息心肌灌注（MP）和壁运动（WM）成像可提高冠状动脉疾病（CAD）的检测率。然而，其在不同临床环境（急诊科和门诊环境）中的预后作用仍不清楚。
在PubMed、Embase数据库和Cochrane图书馆进行系统检索，以评估静息MP和WM在预测主要不良心脏事件（MACE）中的作用，MACE包括死亡、非致命性心肌梗死（NFMI）以及因疑似有症状CAD而就诊于门诊或急诊科的患者进行紧急血运重建。使用RevMan 5.3应用汇总接受者操作特征（SROC）曲线、敏感性和特异性图来评估诊断性能。
七项研究符合标准，包括3668例患者（六项研究随访时间为2天至2.6年）。与静息MP和WM正常的患者相比，静息MP和WM均异常的患者预测MACE的相对风险（RR）为6.1（95%CI，5.1 - 7.2），死亡/NFMI的RR为14.3（95%CI，10.3 - 19.8）。与静息MP正常但WM异常的患者相比，静息MP和WM均异常也更能预测MACE（RR，1.7；95%CI 1.5 - 1.9）和死亡/NFMI（RR，2.2；95%CI，1.8 - 2.7）。
在这项针对疑似CAD的急诊科和门诊就诊患者的荟萃分析中，静息区域MP和WM均异常可识别出不良事件风险最高的患者。
