Prognostic value of high-dose dipyridamole stress myocardial contrast perfusion echocardiography

Nicola Gaibazzi, Claudio Reverberi, Valentina Lorenzoni, Sabrina Molinaro, Thomas Richard Porter

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background-The addition of myocardial perfusion (MP) imaging during dipyridamole real-time contrast echocardiography improves the sensitivity to detect coronary artery disease, but its prognostic value to predict hard cardiac events in large numbers of patients with known or suspected coronary artery disease remains unknown. Methods and Results-We studied 1252 patients with the use of dipyridamole real-time contrast echocardiography and followed them for a median of 25 months. The prognostic value of MP imaging regarding death and nonfatal myocardial infarction was determined and related to wall motion (WM), clinical risk factors, and rest ejection fraction by the use of Cox proportional-hazards models, C index, and risk reclassification analysis. A total of 59 hard events (4.7%) occurred during the follow-up (24 deaths, 35 myocardial infarctions). The 2-year event-free survival was 97.9% in patients with normal MP and WM, 91.9% with isolated reversible MP defects but normal WM, and 67.4% with both reversible MP and WM abnormalities (P<0.001). By multivariate analysis the independent predictors of events were age (hazard ratio 1.05, 95% confidence interval [CI], 1.02-1.08), sex (hazard ratio, 2.36; 95% CI, 1.32-4.23), reversible MP defects (hazard ratio, 3.88; 95% CI, 1.83-8.21), and reversible WM abnormalities with reversible MP defects (hazard ratio, 4.51; 95% CI, 2.25-9.07). Reversible MP defects added incremental predictive value and reclassification benefit over WM response and clinical factors (P=0.001). Conclusions-MP imaging using real-time perfusion echocardiography during dipyridamole real-time contrast echocardiography provides independent, incremental prognostic information regarding hard cardiac events in patients with known or suspected coronary artery disease. Patients with normal MP responses have better outcome than patients with normal WM; patients with both reversible WM and MP abnormalities have the worst outcome.

Original languageEnglish (US)
Pages (from-to)1217-1224
Number of pages8
JournalCirculation
Volume126
Issue number10
DOIs
StatePublished - Sep 4 2012

Fingerprint

Dipyridamole
Echocardiography
Perfusion
Myocardial Perfusion Imaging
Confidence Intervals
Coronary Artery Disease
Myocardial Infarction
Sex Ratio
Proportional Hazards Models
Disease-Free Survival
Multivariate Analysis

Keywords

  • coronary artery disease
  • dipyridamole
  • myocardial contrast echocardiography
  • prognosis
  • stress echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Prognostic value of high-dose dipyridamole stress myocardial contrast perfusion echocardiography. / Gaibazzi, Nicola; Reverberi, Claudio; Lorenzoni, Valentina; Molinaro, Sabrina; Porter, Thomas Richard.

In: Circulation, Vol. 126, No. 10, 04.09.2012, p. 1217-1224.

Research output: Contribution to journalArticle

Gaibazzi, Nicola ; Reverberi, Claudio ; Lorenzoni, Valentina ; Molinaro, Sabrina ; Porter, Thomas Richard. / Prognostic value of high-dose dipyridamole stress myocardial contrast perfusion echocardiography. In: Circulation. 2012 ; Vol. 126, No. 10. pp. 1217-1224.
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abstract = "Background-The addition of myocardial perfusion (MP) imaging during dipyridamole real-time contrast echocardiography improves the sensitivity to detect coronary artery disease, but its prognostic value to predict hard cardiac events in large numbers of patients with known or suspected coronary artery disease remains unknown. Methods and Results-We studied 1252 patients with the use of dipyridamole real-time contrast echocardiography and followed them for a median of 25 months. The prognostic value of MP imaging regarding death and nonfatal myocardial infarction was determined and related to wall motion (WM), clinical risk factors, and rest ejection fraction by the use of Cox proportional-hazards models, C index, and risk reclassification analysis. A total of 59 hard events (4.7{\%}) occurred during the follow-up (24 deaths, 35 myocardial infarctions). The 2-year event-free survival was 97.9{\%} in patients with normal MP and WM, 91.9{\%} with isolated reversible MP defects but normal WM, and 67.4{\%} with both reversible MP and WM abnormalities (P<0.001). By multivariate analysis the independent predictors of events were age (hazard ratio 1.05, 95{\%} confidence interval [CI], 1.02-1.08), sex (hazard ratio, 2.36; 95{\%} CI, 1.32-4.23), reversible MP defects (hazard ratio, 3.88; 95{\%} CI, 1.83-8.21), and reversible WM abnormalities with reversible MP defects (hazard ratio, 4.51; 95{\%} CI, 2.25-9.07). Reversible MP defects added incremental predictive value and reclassification benefit over WM response and clinical factors (P=0.001). Conclusions-MP imaging using real-time perfusion echocardiography during dipyridamole real-time contrast echocardiography provides independent, incremental prognostic information regarding hard cardiac events in patients with known or suspected coronary artery disease. Patients with normal MP responses have better outcome than patients with normal WM; patients with both reversible WM and MP abnormalities have the worst outcome.",
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T1 - Prognostic value of high-dose dipyridamole stress myocardial contrast perfusion echocardiography

AU - Gaibazzi, Nicola

AU - Reverberi, Claudio

AU - Lorenzoni, Valentina

AU - Molinaro, Sabrina

AU - Porter, Thomas Richard

PY - 2012/9/4

Y1 - 2012/9/4

N2 - Background-The addition of myocardial perfusion (MP) imaging during dipyridamole real-time contrast echocardiography improves the sensitivity to detect coronary artery disease, but its prognostic value to predict hard cardiac events in large numbers of patients with known or suspected coronary artery disease remains unknown. Methods and Results-We studied 1252 patients with the use of dipyridamole real-time contrast echocardiography and followed them for a median of 25 months. The prognostic value of MP imaging regarding death and nonfatal myocardial infarction was determined and related to wall motion (WM), clinical risk factors, and rest ejection fraction by the use of Cox proportional-hazards models, C index, and risk reclassification analysis. A total of 59 hard events (4.7%) occurred during the follow-up (24 deaths, 35 myocardial infarctions). The 2-year event-free survival was 97.9% in patients with normal MP and WM, 91.9% with isolated reversible MP defects but normal WM, and 67.4% with both reversible MP and WM abnormalities (P<0.001). By multivariate analysis the independent predictors of events were age (hazard ratio 1.05, 95% confidence interval [CI], 1.02-1.08), sex (hazard ratio, 2.36; 95% CI, 1.32-4.23), reversible MP defects (hazard ratio, 3.88; 95% CI, 1.83-8.21), and reversible WM abnormalities with reversible MP defects (hazard ratio, 4.51; 95% CI, 2.25-9.07). Reversible MP defects added incremental predictive value and reclassification benefit over WM response and clinical factors (P=0.001). Conclusions-MP imaging using real-time perfusion echocardiography during dipyridamole real-time contrast echocardiography provides independent, incremental prognostic information regarding hard cardiac events in patients with known or suspected coronary artery disease. Patients with normal MP responses have better outcome than patients with normal WM; patients with both reversible WM and MP abnormalities have the worst outcome.

AB - Background-The addition of myocardial perfusion (MP) imaging during dipyridamole real-time contrast echocardiography improves the sensitivity to detect coronary artery disease, but its prognostic value to predict hard cardiac events in large numbers of patients with known or suspected coronary artery disease remains unknown. Methods and Results-We studied 1252 patients with the use of dipyridamole real-time contrast echocardiography and followed them for a median of 25 months. The prognostic value of MP imaging regarding death and nonfatal myocardial infarction was determined and related to wall motion (WM), clinical risk factors, and rest ejection fraction by the use of Cox proportional-hazards models, C index, and risk reclassification analysis. A total of 59 hard events (4.7%) occurred during the follow-up (24 deaths, 35 myocardial infarctions). The 2-year event-free survival was 97.9% in patients with normal MP and WM, 91.9% with isolated reversible MP defects but normal WM, and 67.4% with both reversible MP and WM abnormalities (P<0.001). By multivariate analysis the independent predictors of events were age (hazard ratio 1.05, 95% confidence interval [CI], 1.02-1.08), sex (hazard ratio, 2.36; 95% CI, 1.32-4.23), reversible MP defects (hazard ratio, 3.88; 95% CI, 1.83-8.21), and reversible WM abnormalities with reversible MP defects (hazard ratio, 4.51; 95% CI, 2.25-9.07). Reversible MP defects added incremental predictive value and reclassification benefit over WM response and clinical factors (P=0.001). Conclusions-MP imaging using real-time perfusion echocardiography during dipyridamole real-time contrast echocardiography provides independent, incremental prognostic information regarding hard cardiac events in patients with known or suspected coronary artery disease. Patients with normal MP responses have better outcome than patients with normal WM; patients with both reversible WM and MP abnormalities have the worst outcome.

KW - coronary artery disease

KW - dipyridamole

KW - myocardial contrast echocardiography

KW - prognosis

KW - stress echocardiography

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