Diagnostic accuracy and prognostic value of dobutamine stress myocardial contrast echocardiography in patients with suspected acute coronary syndromes

Jeane M. Tsutsui, Feng Xie, Edward Lewis O'Leary, Abdou Elhendy, James R. Anderson, Anna C. McGrain, Thomas Richard Porter

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Background: Both early stress testing and cardiac troponin I (cTnI) measurements are useful in assessing the prognosis of patients with acute coronary syndrome (ACS). We sought to determine the accuracy and prognostic value of wall motion analysis (WMA) and myocardial perfusion analysis (MPA) with real-time myocardial contrast echocardiography (RTMCE) during dobutamine stress in this patient population. Methods: We performed dobutamine stress RTMCE to assess perfusion in 158 consecutive patients (mean age: 61 ± 13 years) with chest pain and possible ACS. Of these, 119 had normal cTnI, while 39 had isolated elevations of cTnI (range: 0.5-9.0 ng/ml). Quantitative angiography was performed within 1 month of RTMCE in 61 patients. Patients were followed for 16 months (range: 6-46 months). Cardiac events included death, nonfatal myocardial infarction, recurrent unstable angina, or need for urgent revascularization. Results: The sensitivity, specificity, and accuracy of MPA for detecting a >50% coronary stenosis were 92%, 77%, and 88%, respectively, while they were 62%, 85%, and 67% for WMA. Three-year event-free survival was 87% in patients with negative WMA and MPA, 49% in those with positive WMA and MPA, and 51% in patients with negative WMA but positive MPA. Age-adjusted multivariate analysis demonstrated that the only independent predictors of cardiac events were a positive MPA (hazard ratio = 3.23; 95% CI = 1.23-8.49) and male sex (hazard ratio = 3.29; 95% CI = 1.21-8.97). Conclusions: In patients suspected of having an ACS, RTMCE improved the accuracy of dobutamine stress echocardiography for detecting coronary artery disease, and was an independent predictor of outcome.

Original languageEnglish (US)
Pages (from-to)487-495
Number of pages9
JournalEchocardiography
Volume22
Issue number6
DOIs
StatePublished - Jul 1 2005

Fingerprint

Dobutamine
Acute Coronary Syndrome
Echocardiography
Perfusion
Troponin I
Stress Echocardiography
Coronary Stenosis
Unstable Angina
Sex Ratio
Chest Pain
Disease-Free Survival
Coronary Artery Disease
Angiography
Multivariate Analysis
Myocardial Infarction
Sensitivity and Specificity

Keywords

  • Chest pain
  • Myocardial contrast echocardiography
  • Prognosis
  • Stress

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Diagnostic accuracy and prognostic value of dobutamine stress myocardial contrast echocardiography in patients with suspected acute coronary syndromes. / Tsutsui, Jeane M.; Xie, Feng; O'Leary, Edward Lewis; Elhendy, Abdou; Anderson, James R.; McGrain, Anna C.; Porter, Thomas Richard.

In: Echocardiography, Vol. 22, No. 6, 01.07.2005, p. 487-495.

Research output: Contribution to journalArticle

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abstract = "Background: Both early stress testing and cardiac troponin I (cTnI) measurements are useful in assessing the prognosis of patients with acute coronary syndrome (ACS). We sought to determine the accuracy and prognostic value of wall motion analysis (WMA) and myocardial perfusion analysis (MPA) with real-time myocardial contrast echocardiography (RTMCE) during dobutamine stress in this patient population. Methods: We performed dobutamine stress RTMCE to assess perfusion in 158 consecutive patients (mean age: 61 ± 13 years) with chest pain and possible ACS. Of these, 119 had normal cTnI, while 39 had isolated elevations of cTnI (range: 0.5-9.0 ng/ml). Quantitative angiography was performed within 1 month of RTMCE in 61 patients. Patients were followed for 16 months (range: 6-46 months). Cardiac events included death, nonfatal myocardial infarction, recurrent unstable angina, or need for urgent revascularization. Results: The sensitivity, specificity, and accuracy of MPA for detecting a >50{\%} coronary stenosis were 92{\%}, 77{\%}, and 88{\%}, respectively, while they were 62{\%}, 85{\%}, and 67{\%} for WMA. Three-year event-free survival was 87{\%} in patients with negative WMA and MPA, 49{\%} in those with positive WMA and MPA, and 51{\%} in patients with negative WMA but positive MPA. Age-adjusted multivariate analysis demonstrated that the only independent predictors of cardiac events were a positive MPA (hazard ratio = 3.23; 95{\%} CI = 1.23-8.49) and male sex (hazard ratio = 3.29; 95{\%} CI = 1.21-8.97). Conclusions: In patients suspected of having an ACS, RTMCE improved the accuracy of dobutamine stress echocardiography for detecting coronary artery disease, and was an independent predictor of outcome.",
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T1 - Diagnostic accuracy and prognostic value of dobutamine stress myocardial contrast echocardiography in patients with suspected acute coronary syndromes

AU - Tsutsui, Jeane M.

AU - Xie, Feng

AU - O'Leary, Edward Lewis

AU - Elhendy, Abdou

AU - Anderson, James R.

AU - McGrain, Anna C.

AU - Porter, Thomas Richard

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KW - Prognosis

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