Prognostic value of dobutamine stress myocardial perfusion echocardiography in patients with known or suspected coronary artery disease and normal left ventricular function

Angele A A Mattoso, Jeane M. Tsutsui, Ingrid Kowatsch, Vitória Y L Cruz, João C N Sbano, Henrique B. Ribeiro, Roberto Kalil Filho, Thomas Richard Porter, Wilson Mathias

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective We sought to determine the prognostic value of qualitative and quantitative analysis obtained by real-time myocardial perfusion echocardiography (RTMPE) in patients with known or suspected coronary artery disease (CAD). Background Quantification of myocardial blood flow reserve (MBFR) in patients with CAD using RTMPE has been demonstrated to further improve accuracy over the analysis of wall motion (WM) and qualitative analysis of myocardial perfusion (QMP). Methods From March 2003 to December 2008, we prospectively studied 168 patients with normal left ventricular function (LVF) who underwent dobutamine stress RTMPE. The replenishment velocity reserve (β) and MBFR were derived from RTMPE. Acute coronary events were: cardiac death, myocardial infarction and unstable angina with need for urgent coronary revascularization. Results During a median follow-up of 34 months (5 days to 6.9 years), 17 acute coronary events occurred. Abnormal β reserve in ≥2 coronary territories was the only independent predictor of events hazard ratio (HR) = 21, 95% CI = 4.5-99; p<0.001). Both, abnormal β reserve and MBFR added significant incremental value in predicting events over qualitative analysis of WMand MP (Χ2 = 6.6 and Χ2 = 24.6, respectively; p = 0.001 and Χ2 = 6.6 and Χ2 = 15.5, respectively; p = 0.012, respectively). When coronary angiographic data was added to the multivariate analysis model, β reserve remained the only predictor of events with HR of 21.0 (95% CI = 4.5-99); p<0.001. Conclusion Quantitative dobutamine stress RTMPE provides incremental prognostic information over clinical variables, qualitative analysis ofWM and MP, and coronary angiography in predicting acute coronary events.

Original languageEnglish (US)
Article numbere0172280
JournalPLoS One
Volume12
Issue number2
DOIs
StatePublished - Feb 1 2017

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Echocardiography
Dobutamine
echocardiography
Left Ventricular Function
Coronary Artery Disease
qualitative analysis
Perfusion
blood flow
Blood
Hazards
Angiography
myocardial infarction
Unstable Angina
multivariate analysis
quantitative analysis
Coronary Angiography
coronary artery disease
death
Multivariate Analysis
Myocardial Infarction

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Prognostic value of dobutamine stress myocardial perfusion echocardiography in patients with known or suspected coronary artery disease and normal left ventricular function. / Mattoso, Angele A A; Tsutsui, Jeane M.; Kowatsch, Ingrid; Cruz, Vitória Y L; Sbano, João C N; Ribeiro, Henrique B.; Filho, Roberto Kalil; Porter, Thomas Richard; Mathias, Wilson.

In: PLoS One, Vol. 12, No. 2, e0172280, 01.02.2017.

Research output: Contribution to journalArticle

Mattoso, Angele A A ; Tsutsui, Jeane M. ; Kowatsch, Ingrid ; Cruz, Vitória Y L ; Sbano, João C N ; Ribeiro, Henrique B. ; Filho, Roberto Kalil ; Porter, Thomas Richard ; Mathias, Wilson. / Prognostic value of dobutamine stress myocardial perfusion echocardiography in patients with known or suspected coronary artery disease and normal left ventricular function. In: PLoS One. 2017 ; Vol. 12, No. 2.
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abstract = "Objective We sought to determine the prognostic value of qualitative and quantitative analysis obtained by real-time myocardial perfusion echocardiography (RTMPE) in patients with known or suspected coronary artery disease (CAD). Background Quantification of myocardial blood flow reserve (MBFR) in patients with CAD using RTMPE has been demonstrated to further improve accuracy over the analysis of wall motion (WM) and qualitative analysis of myocardial perfusion (QMP). Methods From March 2003 to December 2008, we prospectively studied 168 patients with normal left ventricular function (LVF) who underwent dobutamine stress RTMPE. The replenishment velocity reserve (β) and MBFR were derived from RTMPE. Acute coronary events were: cardiac death, myocardial infarction and unstable angina with need for urgent coronary revascularization. Results During a median follow-up of 34 months (5 days to 6.9 years), 17 acute coronary events occurred. Abnormal β reserve in ≥2 coronary territories was the only independent predictor of events hazard ratio (HR) = 21, 95{\%} CI = 4.5-99; p<0.001). Both, abnormal β reserve and MBFR added significant incremental value in predicting events over qualitative analysis of WMand MP (Χ2 = 6.6 and Χ2 = 24.6, respectively; p = 0.001 and Χ2 = 6.6 and Χ2 = 15.5, respectively; p = 0.012, respectively). When coronary angiographic data was added to the multivariate analysis model, β reserve remained the only predictor of events with HR of 21.0 (95{\%} CI = 4.5-99); p<0.001. Conclusion Quantitative dobutamine stress RTMPE provides incremental prognostic information over clinical variables, qualitative analysis ofWM and MP, and coronary angiography in predicting acute coronary events.",
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T1 - Prognostic value of dobutamine stress myocardial perfusion echocardiography in patients with known or suspected coronary artery disease and normal left ventricular function

AU - Mattoso, Angele A A

AU - Tsutsui, Jeane M.

AU - Kowatsch, Ingrid

AU - Cruz, Vitória Y L

AU - Sbano, João C N

AU - Ribeiro, Henrique B.

AU - Filho, Roberto Kalil

AU - Porter, Thomas Richard

AU - Mathias, Wilson

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Objective We sought to determine the prognostic value of qualitative and quantitative analysis obtained by real-time myocardial perfusion echocardiography (RTMPE) in patients with known or suspected coronary artery disease (CAD). Background Quantification of myocardial blood flow reserve (MBFR) in patients with CAD using RTMPE has been demonstrated to further improve accuracy over the analysis of wall motion (WM) and qualitative analysis of myocardial perfusion (QMP). Methods From March 2003 to December 2008, we prospectively studied 168 patients with normal left ventricular function (LVF) who underwent dobutamine stress RTMPE. The replenishment velocity reserve (β) and MBFR were derived from RTMPE. Acute coronary events were: cardiac death, myocardial infarction and unstable angina with need for urgent coronary revascularization. Results During a median follow-up of 34 months (5 days to 6.9 years), 17 acute coronary events occurred. Abnormal β reserve in ≥2 coronary territories was the only independent predictor of events hazard ratio (HR) = 21, 95% CI = 4.5-99; p<0.001). Both, abnormal β reserve and MBFR added significant incremental value in predicting events over qualitative analysis of WMand MP (Χ2 = 6.6 and Χ2 = 24.6, respectively; p = 0.001 and Χ2 = 6.6 and Χ2 = 15.5, respectively; p = 0.012, respectively). When coronary angiographic data was added to the multivariate analysis model, β reserve remained the only predictor of events with HR of 21.0 (95% CI = 4.5-99); p<0.001. Conclusion Quantitative dobutamine stress RTMPE provides incremental prognostic information over clinical variables, qualitative analysis ofWM and MP, and coronary angiography in predicting acute coronary events.

AB - Objective We sought to determine the prognostic value of qualitative and quantitative analysis obtained by real-time myocardial perfusion echocardiography (RTMPE) in patients with known or suspected coronary artery disease (CAD). Background Quantification of myocardial blood flow reserve (MBFR) in patients with CAD using RTMPE has been demonstrated to further improve accuracy over the analysis of wall motion (WM) and qualitative analysis of myocardial perfusion (QMP). Methods From March 2003 to December 2008, we prospectively studied 168 patients with normal left ventricular function (LVF) who underwent dobutamine stress RTMPE. The replenishment velocity reserve (β) and MBFR were derived from RTMPE. Acute coronary events were: cardiac death, myocardial infarction and unstable angina with need for urgent coronary revascularization. Results During a median follow-up of 34 months (5 days to 6.9 years), 17 acute coronary events occurred. Abnormal β reserve in ≥2 coronary territories was the only independent predictor of events hazard ratio (HR) = 21, 95% CI = 4.5-99; p<0.001). Both, abnormal β reserve and MBFR added significant incremental value in predicting events over qualitative analysis of WMand MP (Χ2 = 6.6 and Χ2 = 24.6, respectively; p = 0.001 and Χ2 = 6.6 and Χ2 = 15.5, respectively; p = 0.012, respectively). When coronary angiographic data was added to the multivariate analysis model, β reserve remained the only predictor of events with HR of 21.0 (95% CI = 4.5-99); p<0.001. Conclusion Quantitative dobutamine stress RTMPE provides incremental prognostic information over clinical variables, qualitative analysis ofWM and MP, and coronary angiography in predicting acute coronary events.

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