title: A multicenter, prospective study to evaluate the use of contrast stress echocardiography in early menopausal women at risk for coronary artery disease: trial design and baseline findings.
abstract: OBJECTIVE
  This multisite prospective trial, Stress Echocardiography in Menopausal Women At Risk for Coronary Artery Disease (SMART), aimed to evaluate the prognostic value of contrast stress echocardiography (CSE), coronary artery calcification (CAC), and cardiac biomarkers for prediction of cardiovascular events after 2 and 5 years in early menopausal women experiencing chest pain symptoms or risk factors. This report describes the study design, population, and initial test results at study entry.
  
  
  METHODS
  From January 2004 through September 2007, 366 early menopausal women (age 54±5 years, Framingham risk score 6.51%±4.4 %, range 1%-27%) referred for stress echocardiography were prospectively enrolled. Image quality was enhanced with an ultrasound contrast agent. Tests for cardiac biomarkers [high-sensitivity C-reactive protein (hsCRP), atrial natriuretic protein (ANP), brain natriuretic protein (BNP), endothelin (ET-1)] and cardiac computed tomography (CT) for CAC were performed.
  
  
  RESULTS
  CSE (76% exercise, 24% dobutamine) was abnormal in 42 women (11.5%), and stress electrocardiogram (ECG) was positive in 22 women (6%). Rest BNP correlated weakly with stress wall motion score index (WMSI) (r=0.189, p<0.001). Neither hsCRP, ANP, endothelin, nor CAC correlated with stress WMSI. Predictors of abnormal CSE were body mass index (BMI), diabetes mellitus, family history of premature coronary artery disease (CAD), and positive stress ECG. Twenty-four women underwent clinically indicated coronary angiography (CA); 5 had obstructive (≥50%), 15 had nonobstructive (10%-49%), and 4 had no epicardial CAD.
  
  
  CONCLUSIONS
  The SMART trial is designed to assess the prognostic value of CSE in early menopausal women. Independent predictors of positive CSE were BMI, diabetes mellitus, family history of premature CAD, and positive stress ECG. CAC scores and biomarkers (with the exception of rest BNP) were not correlated with CSE results. We await the follow-up data.
authors: Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
authors: Sahar S
authors: SS
authors: Abdelmoneim
authors: Mathieu
authors: M
authors: Bernier
authors: Mary E
authors: ME
authors: Hagen
authors: Susan
authors: S
authors: Eifert-Rain
authors: Dalene
authors: D
authors: Bott-Kitslaar
authors: Susan
authors: S
authors: Wilansky
authors: Ramon
authors: R
authors: Castello
authors: Gajanan
authors: G
authors: Bhat
authors: Patricia A
authors: PA
authors: Pellikka
authors: Patricia J M
authors: PJ
authors: Best
authors: Sharonne N
authors: SN
authors: Hayes
authors: Sharon L
authors: SL
authors: Mulvagh
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis*; D015992:Body Mass Index; D002637:Chest Pain / Q000209:etiology*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D025401:Echocardiography, Stress / Q000379:methods / Q000706:statistics & numerical data*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008593:Menopause; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers
references: Circulation. 2011 Sep 13;124(11):1239-49
references: 21844080
references: J Nucl Cardiol. 2004 Jul-Aug;11(4):450-7
references: 15295414
references: Circulation. 2003 May 27;107(20):2571-6
references: 12743005
references: Am J Cardiol. 1994 Sep 1;74(5):435-8
references: 8059721
references: Circulation. 1997 Jan 21;95(2):405-10
references: 9008457
references: J Am Coll Cardiol. 2009 Oct 20;54(17):1561-75
references: 19833255
references: J Nucl Cardiol. 2009 Jan-Feb;16(1):105-12
references: 19152135
references: JAMA. 2005 Jan 26;293(4):477-84
references: 15671433
references: J Am Soc Echocardiogr. 2006 Jun;19(6):772-6
references: 16762755
references: Ann Intern Med. 1994 Apr 1;120(7):559-66
references: 8116993
references: Circulation. 2010 Dec 14;122(24):2570-80
references: 21156655
references: J Am Soc Echocardiogr. 2007 Sep;20(9):1021-41
references: 17765820
references: J Am Coll Cardiol. 2002 Feb 20;39(4):625-31
references: 11849861
references: Circulation. 1998 Aug 25;98(8):731-3
references: 9727541
references: Radiology. 2003 Sep;228(3):826-33
references: 12869688
references: Arch Intern Med. 2009 May 11;169(9):843-50
references: 19433695
references: JACC Cardiovasc Imaging. 2009 Sep;2(9):1048-56
references: 19761981
references: J Am Coll Cardiol. 1998 Dec;32(7):1975-81
references: 9857881
references: J Formos Med Assoc. 1998 Dec;97(12):812-8
references: 9884482
references: J Am Coll Cardiol. 2006 Feb 7;47(3 Suppl):S59-62
references: 16458173
references: Circulation. 2003 Jan 21;107(2):245-50
references: 12538423
references: Catheter Cardiovasc Interv. 2002 Jun;56(2):174-7
references: 12112908
references: J Am Coll Cardiol. 2006 Nov 21;48(10):2125-31
references: 17113002
references: J Am Soc Echocardiogr. 2010 Feb;23(2):207-14
references: 20152703
references: J Am Coll Cardiol. 2004 Aug 18;44(4):923-30
references: 15312881
references: J Am Coll Cardiol. 2010 Nov 23;56(22):1864-94
references: 21087721
references: J Am Coll Cardiol. 1995 Aug;26(2):335-41
references: 7608432
references: J Am Coll Cardiol. 1997 Aug;30(2):414-20
references: 9247513
references: Circulation. 2003 Jan 28;107(3):499-511
references: 12551878
references: Cardiovasc Ultrasound. 2008 Jul 18;6:37
references: 18638372
references: N Engl J Med. 1979 Jun 14;300(24):1350-8
references: 440357
references: Am J Cardiol. 2010 Feb 15;105(4):453-8
references: 20152238
references: J Am Coll Cardiol. 1998 Sep;32(3):746-52
references: 9741522
references: Circulation. 2010 Dec 21;122(25):e584-636
references: 21098428
references: Eur J Echocardiogr. 2007 Jun;8(3):S13-23
references: 17481562
references: Am J Physiol Heart Circ Physiol. 2008 Sep;295(3):H931-H938
references: 18621859
references: Int J Cardiol. 2008 Feb 29;124(2):204-10
references: 17442418
references: Circulation. 2006 Mar 7;113(9):1156-8
references: 16520422
references: J Am Soc Echocardiogr. 2008 Nov;21(11):1179-201; quiz 1281
references: 18992671
references: Heart. 2000 Dec;84(6):668A-69
references: 11083752
references: Am J Cardiol. 1987 Mar 9;59(7):23C-30C
references: 2950748