title: Prognostic value of high-dose dipyridamole stress myocardial contrast perfusion echocardiography.
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.
  
  
  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.
authors.affiliation: Parma University Hospital, Via Gramsci, 14, 43124 Parma, Italy. ngaibazzi@gmail.com
authors.forename: Nicola
authors.initials: N
authors.lastname: Gaibazzi
authors.forename: Claudio
authors.initials: C
authors.lastname: Reverberi
authors.forename: Valentina
authors.initials: V
authors.lastname: Lorenzoni
authors.forename: Sabrina
authors.initials: S
authors.lastname: Molinaro
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Porter
mesh_terms: D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D004176:Dipyridamole / Q000008:administration & dosage; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D003287:Contrast Media; D014665:Vasodilator Agents; D004176:Dipyridamole