title: Role of contrast-enhanced dobutamine stress echocardiography in predicting outcome in patients with known or suspected coronary artery disease.
abstract: Although the application of intravenous contrast agents during stress echocardiography has been shown to improve diagnostic accuracy for detecting coronary artery disease, less information exists regarding its prognostic value. The aim of this study was to determine the role of contrast-enhanced dobutamine stress echocardiography (DSE) for predicting future cardiac events in patients with coronary artery disease (CAD). We studied 893 patients (mean age: 66, 581 men) with known or suspected CAD undergoing contrast-enhanced DSE. Positivity was defined as new/worsened wall motion abnormality or fixed abnormality during stress. All patients were followed for 15 +/- 10 months to evaluate hard cardiac events (cardiac death and nonfatal myocardial infarction) and total cardiac events (hard cardiac events, congestive heart failure, unstable angina, and late revascularization). Three patients were lost to follow-up, and 128 patients developed cardiac events, including 21 hard cardiac events. The 3-year event free survival rate was significantly lower in patients with positive DSE results than in those with negative DSE results. Stepwise Cox multivariate analysis revealed that positivity of DSE (P < 0.0001, Hazard ratio (HR): 2.48) and peak wall motion score index (WMSI) >1.5 (P < 0.0001, HR: 2.41) were independent predictors for total cardiac events. Considering hard cardiac events, the independent predictors were peak WMSI > 1.5 (P < 0.0001, HR: 6.65) and age > 70 years (P < 0.005, HR: 3.27). We conclude that contrast-enhanced DSE provides important prognostic information for future cardiac events.
authors.affiliation: Department of Internal Medicine and Cardiology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Ryotaro
authors.initials: R
authors.lastname: Wake
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Yoshitani
authors.forename: Chinami
authors.initials: C
authors.lastname: Miyazaki
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Otani
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoshiyama
authors.forename: Junichi
authors.initials: J
authors.lastname: Yoshikawa
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001794:Blood Pressure; D003287:Contrast Media / Q000008:administration & dosage; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018572:Disease-Free Survival; D025401:Echocardiography, Stress / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012107:Research Design; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate
chemical_list: D003287:Contrast Media