Document Detail

Prognostic value of dobutamine stress myocardial contrast perfusion echocardiography.
MedLine Citation:
PMID:  16129798     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Myocardial perfusion (MP) imaging with real-time contrast echocardiography (RTCE) improves the sensitivity of dobutamine stress echocardiography for detecting coronary artery disease. Its prognostic value is unknown. We sought to determine the value of MP and wall motion (WM) analysis during dobutamine stress echocardiography in predicting the outcome of patients with known or suspected coronary artery disease. METHODS AND RESULTS: We retrospectively studied 788 patients with RTCE during dobutamine stress echocardiography using intravenous commercially available contrast agents. The incremental prognostic value of MP imaging over clinical risk factors and other echocardiographic data was examined through the use of a log-likelihood test (Cox model). During a median follow-up of 20 months, 75 events (9.6%) occurred (58 deaths, 17 nonfatal myocardial infarctions). Abnormal MP had significant incremental value over clinical factors, resting ejection fraction, and WM responses in predicting events (P<0.001). By multivariate analysis, the independent predictors of death and nonfatal myocardial infarction were resting left ventricular ejection fraction <50% (relative risk [RR], 1.9; 95% CI, 1.2 to 3.2; P=0.01), hypercholesterolemia (RR, 0.5; 95% CI, 0.3 to 0.9; P=0.01), and abnormal MP (RR, 5.2; 95% CI, 3.0 to 9.0; P<0.0001). The 3-year event free survival was 95% for patients with normal WM and MP, 82% for normal WM and abnormal MP, and 68% for abnormal WM and MP. CONCLUSIONS: MP imaging during dobutamine stress RTCE provides incremental prognostic information in patients with known or suspected coronary artery disease. Patients with normal MP have a better outcome than patients with normal WM.
Jeane M Tsutsui; Abdou Elhendy; James R Anderson; Feng Xie; Anna C McGrain; Thomas R Porter
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2005-08-29
Journal Detail:
Title:  Circulation     Volume:  112     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-09-07     Completed Date:  2006-02-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1444-50     Citation Subset:  AIM; IM    
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-1165, USA.
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MeSH Terms
Cardiotonic Agents / diagnostic use
Contrast Media*
Death, Sudden, Cardiac
Dobutamine / diagnostic use
Echocardiography, Stress / methods*
Exercise Test
Follow-Up Studies
Middle Aged
Myocardial Infarction / mortality*,  ultrasonography*
Predictive Value of Tests
Proportional Hazards Models
Retrospective Studies
Sensitivity and Specificity
Reg. No./Substance:
0/Cardiotonic Agents; 0/Contrast Media; 34368-04-2/Dobutamine
Comment In:
Circulation. 2005 Sep 6;112(10):1382-3   [PMID:  16145012 ]

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