Myocardial Contrast Echocardiography Enhances Long-Term Prognostic Value of Supine Bicycle Stress Two-Dimensional Echocardiography
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 (χ2 = 7.73 vs 12.92, P = .02) and further improved by MCE (χ2 = 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.
aCenter for Diagnosis, Prevention and Telemedicine, John Paul II Hospital, Kraków, Poland
b2nd Department of Internal Medicine, University of Bonn, Bonn, Germany
cDepartment of Internal Medicine, St Marienhospital, Bonn, Germany
d1st Department of Cardiology, Silesian Centre for Heart Disease, Zabrze, Poland
eDepartment of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany
Reprint requests: Tomasz Miszalski-Jamka, MD, Center for Diagnosis, Prevention and Telemedicine, John Paul II Hospital, ul Prądnicka 80, 31-202 Kraków, Poland
Dr Tomasz Miszalski-Jamka was supported by Catholic Academic Exchange Service (Bonn, Germany).
ABSTRACT