title: Prognostic value of dobutamine stress myocardial contrast perfusion echocardiography.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-1165, USA.
authors.forename: Jeane M
authors.initials: JM
authors.lastname: Tsutsui
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: James R
authors.initials: JR
authors.lastname: Anderson
authors.forename: Feng
authors.initials: F
authors.lastname: Xie
authors.forename: Anna C
authors.initials: AC
authors.lastname: McGrain
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Porter
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents; D003287:Contrast Media; D016757:Death, Sudden, Cardiac; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000379:methods*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D002316:Cardiotonic Agents; D003287:Contrast Media; D004280:Dobutamine