title: Myocardial contrast echocardiography enhances long-term prognostic value of supine bicycle stress two-dimensional echocardiography.
abstract: BACKGROUND
  The aim of this study was to determine the incremental prognostic value of myocardial contrast echocardiography (MCE) over two-dimensional echocardiography (2DE) in patients undergoing supine bicycle stress.
  
  
  METHODS
  Eighty-four patients with known or suspected coronary artery disease who underwent supine bicycle stress with 2DE and MCE (mean age, 58.5 +/- 9.7 years; 68 men) were followed up for 48.3 +/- 8.9 months for cardiac death (n = 1), nonfatal myocardial infarction (n = 9), and revascularization (n = 20).
  
  
  RESULTS
  In sequential Cox models, the predictive power of the clinical model was strengthened by 2DE (chi(2) = 7.73 vs 12.92, P = .02) and further improved by MCE (chi(2) = 19.04, P = .01). On multivariate analysis, the only independent follow-up event predictor was ischemia on MCE (hazard ratio, 6.79; 95% confidence interval, 2.02-22.82; P = .001). Among patients with normal results on 2DE, those with normal results on MCE had greater 4.5-year event-free survival than those with abnormal results on MCE (93% vs 69%, P = .01).
  
  
  CONCLUSIONS
  MCE enhances the predictive power of supine bicycle stress 2DE and allows the risk stratification of patients with normal results on 2DE.
authors.affiliation: Center for Diagnosis, Prevention and Telemedicine, John Paul II Hospital, Kraków, Poland. miszalt@mp.pl
authors.forename: Tomasz
authors.initials: T
authors.lastname: Miszalski-Jamka
authors.forename: Stefanie
authors.initials: S
authors.lastname: Kuntz-Hehner
authors.forename: Harald
authors.initials: H
authors.lastname: Schmidt
authors.forename: Daniel
authors.initials: D
authors.lastname: Peter
authors.forename: Karol
authors.initials: K
authors.lastname: Miszalski-Jamka
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: Klaus
authors.initials: K
authors.lastname: Tiemann
authors.forename: Alexander
authors.initials: A
authors.lastname: Ghanem
authors.forename: Clemens
authors.initials: C
authors.lastname: Troatz
authors.forename: Mieczysław
authors.initials: M
authors.lastname: Pasowicz
authors.forename: Berndt
authors.initials: B
authors.lastname: Lüderitz
authors.forename: Heyder
authors.initials: H
authors.lastname: Omran
mesh_terms: D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018572:Disease-Free Survival; D004452:Echocardiography / Q000379:methods*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D016683:Supine Position; D015996:Survival Rate
chemical_list: D003287:Contrast Media