TY - JOUR
T1 - Effect of coronary revascularization on the prognostic value of stress myocardial contrast wall motion and perfusion imaging
AU - Gaibazzi, Nicola
AU - Porter, Thomas
AU - Lorenzoni, Valentina
AU - Pontone, Gianluca
AU - De Santis, Delia D.
AU - De Rosa, Andrea D.
AU - Guaricci, Andrea Igoren
N1 - Publisher Copyright:
© 2017 The Authors.
PY - 2017/6/1
Y1 - 2017/6/1
N2 - Background-The assessment of myocardial perfusion (MP) and wall motion (WM) using contrast dipyridamole echocardiography (cSE-WMP) improves the sensitivity to detect coronary artery disease and the stratification of cardiac events, but its long-term value for fatal and nonfatal ischemic cardiac events, also with respect to patients undergoing revascularization or not, remains to be determined. Methods and Results-One-thousand three-hundred and twenty-nine patients with suspect or known CAD who underwent cSEWMP were followed for a median 5.5 years. The independent prognostic value of cSE-WMP regarding cardiac death or nonfatal myocardial infarction was related to stress WM and MP, rest ejection fraction, clinical risk factors, and medications. Patients revascularized after cSE-WMP were separately analyzed to determine whether the procedure influenced outcome and whether this depends on cSE-WMP results. A total of 125 cardiac fatal and nonfatal ischemic events (9.4%) occurred during the follow-up (61 deaths, 64 myocardial infarctions). The 5-year event rate with normal MP and WM was 5.9%, 9.9% with isolated MP defects (normal WM), and 15.5% with both MP and WM abnormalities. In patients not undergoing revascularization (n = 1111), reversible MP defects added discrimination value over WM response and clinical factors/medication data (P = 0.001), while in the cohort undergoing revascularization (n = 218), cSE-WMP results did not influence outcome. Conclusions-cSE-WMP, with both contrast MP and WM assessments, provides independent, incremental prognostic information regarding ischemic cardiac events at 5 years in patients with known or suspected coronary artery disease. Revascularization reduces cardiac events after an abnormal cSE-WMP, resulting in outcomes not different from those in patients with normal cSE-WMP.
AB - Background-The assessment of myocardial perfusion (MP) and wall motion (WM) using contrast dipyridamole echocardiography (cSE-WMP) improves the sensitivity to detect coronary artery disease and the stratification of cardiac events, but its long-term value for fatal and nonfatal ischemic cardiac events, also with respect to patients undergoing revascularization or not, remains to be determined. Methods and Results-One-thousand three-hundred and twenty-nine patients with suspect or known CAD who underwent cSEWMP were followed for a median 5.5 years. The independent prognostic value of cSE-WMP regarding cardiac death or nonfatal myocardial infarction was related to stress WM and MP, rest ejection fraction, clinical risk factors, and medications. Patients revascularized after cSE-WMP were separately analyzed to determine whether the procedure influenced outcome and whether this depends on cSE-WMP results. A total of 125 cardiac fatal and nonfatal ischemic events (9.4%) occurred during the follow-up (61 deaths, 64 myocardial infarctions). The 5-year event rate with normal MP and WM was 5.9%, 9.9% with isolated MP defects (normal WM), and 15.5% with both MP and WM abnormalities. In patients not undergoing revascularization (n = 1111), reversible MP defects added discrimination value over WM response and clinical factors/medication data (P = 0.001), while in the cohort undergoing revascularization (n = 218), cSE-WMP results did not influence outcome. Conclusions-cSE-WMP, with both contrast MP and WM assessments, provides independent, incremental prognostic information regarding ischemic cardiac events at 5 years in patients with known or suspected coronary artery disease. Revascularization reduces cardiac events after an abnormal cSE-WMP, resulting in outcomes not different from those in patients with normal cSE-WMP.
KW - Cardiac events
KW - Contrast echocardiography
KW - Coronary artery disease
KW - Death
KW - Dipyridamole
KW - Ischemia
KW - Myocardial perfusion
KW - Prognosis
KW - Stress-echocardiography
KW - Wall motion
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U2 - 10.1161/JAHA.117.006202
DO - 10.1161/JAHA.117.006202
M3 - Article
C2 - 28566297
AN - SCOPUS:85020378903
SN - 2047-9980
VL - 6
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 6
M1 - e006202
ER -