title: Real-time dobutamine stress myocardial perfusion echocardiography predicts outcome in the elderly.
abstract: OBJECTIVE
  Although there is an increasing number of studies showing the value of perfusion imaging with real-time contrast echocardiography (RTCE) for detecting coronary artery disease (CAD), no data exist regarding the value of this technique for detecting CAD and predicting outcome in the elderly.
  
  
  RESULTS
  We examined the outcome of 399 patients > or =70 years old who underwent dobutamine stress RTCE for known or suspected CAD. Myocardial perfusion imaging (MPI) was performed using low mechanical index pulse sequence schemes following intravenous small bolus injections of ultrasound contrast. Quantitative coronary angiography (QCA) was performed within 1 month of the stress test in 60 patients. Events were defined as cardiac death or non-fatal myocardial infarction (MI). Sensitivity of MPI for detecting CAD by QCA was 94% [confidence interval (CI) 91-99], specificity was 67% (CI 36-74), and accuracy was 90% (CI 82-95). During a median follow-up of 21 months, 46 events occurred (31 cardiac deaths, 15 non-fatal MI). Univariate predictors of outcome were diuretic use (P = 0.03), abnormal stress wall motion (P < 0.0001), and abnormal stress MPI (P < 0.0001). Abnormal stress MPI, however, was the most significant predictor of outcome (chi(2) 7.5; P = 0.006).
  
  
  CONCLUSIONS
  Myocardial perfusion analysis during dobutamine stress RTCE provides incremental predictive value in determining the outcome of elderly patients being evaluated for the presence of CAD.
authors.affiliation: Section of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, NE 68198-2265, USA.
authors.forename: Jeane M
authors.initials: JM
authors.lastname: Tsutsui
authors.forename: Feng
authors.initials: F
authors.lastname: Xie
authors.forename: David
authors.initials: D
authors.lastname: Cloutier
authors.forename: Saul
authors.initials: S
authors.lastname: Kalvaitis
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Porter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000379:methods*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine