title: Patient outcome following 2 different stress imaging approaches: a prospective randomized comparison.
abstract: OBJECTIVE
  The study sought to prospectively compare patient outcome after stress real-time myocardial contrast echocardiography (RTMCE) versus conventional stress echo (CSE), where contrast is used to optimize wall motion (WM) analysis.
  
  
  BACKGROUND
  Myocardial perfusion imaging with RTMCE may improve the detection of coronary artery disease (CAD), and predict patient outcome.
  
  
  METHODS
  Patients with intermediate to high pre-test probability referred for dobutamine or exercise stress echocardiography were prospectively randomized to either RTMCE or CSE. Definity contrast was used for CSE only when endocardial border delineation was inadequate (63% of studies). Studies were interpreted by either an experienced contrast reviewer (R1; n = 1257), or 4 Level 3 echocardiographers (R2) with basic contrast training (n = 806). Death, nonfatal myocardial infarction (MI), and revascularizations were recorded at follow-up.
  
  
  RESULTS
  Follow-up was available in 2,014 patients (median 2.6 years). Mean age was 59 ± 13 years (53% women). An abnormal RTMCE was more frequently observed than an abnormal CSE (p < 0.001), and more frequently resulted in revascularization (p = 0.004). Resting WM abnormalities were also more frequently seen with RTMCE (p < 0.01), and were an independent predictor of death/nonfatal MI (p = 0.005) for RTMCE, but not CSE. The predictive value of a positive study, whether with CSE or RTMCE, was significant for both R1 and R2 reviewers in predicting the combined endpoint, but R1 was better than R2 at predicting patients at risk for death or nonfatal MI.
  
  
  CONCLUSIONS
  Perfusion imaging with RTMCE improves the detection of CAD during stress echocardiography, and identifies those more likely to undergo revascularization following an abnormal study.
authors: Department of Cardiology, Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska. Electronic address: trporter@unmc.edu.
authors: Thomas R
authors: TR
authors: Porter
authors: College of Public Health Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska.
authors: Lynette M
authors: LM
authors: Smith
authors: Department of Cardiology, Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors: Juefei
authors: J
authors: Wu
authors: Department of Cardiology, Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors: Deepak
authors: D
authors: Thomas
authors: Department of Cardiology, Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors: John T
authors: JT
authors: Haas
authors: Department of Cardiology, Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors: Daniel H
authors: DH
authors: Mathers
authors: Department of Cardiology, Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors: Eric
authors: E
authors: Williams
authors: Department of Cardiology, Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors: Joan
authors: J
authors: Olson
authors: Department of Cardiology, Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors: Kevin
authors: K
authors: Nalty
authors: Department of Cardiology, Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors: Roberta
authors: R
authors: Hess
authors: Department of Cardiology, Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors: Stacey
authors: S
authors: Therrien
authors: Department of Cardiology, Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors: Feng
authors: F
authors: Xie
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D003287:Contrast Media / Q000494:pharmacology; D018572:Disease-Free Survival; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D009068:Movement; D009206:Myocardium / Q000473:pathology*; D011336:Probability; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media