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Published on: February 16, 2016
Prognostic value of dipyridamole stress myocardial contrast echocardiography: comparison with single photon emission
Dana Dawson1, Sanjiv Kaul, Dawn Peters
1Division of Cardiovascular Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA.
Insights
Dipyridamole stress myocardial contrast echocardiography (MCE) offers superior prognostic value for detecting coronary artery disease (CAD) compared to SPECT. MCE accurately predicts adverse cardiac events, guiding patient management and risk stratification.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) detection often relies on imaging modalities.
- Dipyridamole stress myocardial contrast echocardiography (MCE) assesses myocardial blood volume and velocity.
- Single photon-emission computed tomography (SPECT) primarily measures myocardial blood volume.
Purpose of the Study:
- To compare the prognostic utility of MCE versus SPECT in patients with known or suspected CAD.
- To evaluate if MCE's assessment of blood flow velocity enhances prognostic accuracy over SPECT.
- To determine if perfusion abnormalities on MCE are superior to wall thickening (WT) abnormalities for predicting outcomes.
Main Methods:
- A cohort of 261 patients with known or suspected CAD underwent simultaneous dipyridamole stress MCE and 99mTc-sestamibi SPECT.
- Patient outcomes (nonfatal myocardial infarction, cardiac death) were tracked over a 14-month mean follow-up.
- Survival curves were compared using log-rank tests.
Main Results:
- Abnormal MCE results were the strongest predictor of adverse outcomes (OR 23, P<.0001).
- MCE provided prognostic value incremental to clinical factors, WT abnormalities, and SPECT.
- Patients with abnormal MCE and inducible WT abnormalities had the worst prognosis, while those with neither had the best.
Conclusions:
- Dipyridamole stress MCE offers powerful prognostic information in CAD patients, surpassing clinical variables, ECG, LV function, WT analysis, and SPECT.
- MCE is a potentially preferred method for myocardial perfusion assessment in patients with known or suspected CAD.
- Larger studies are recommended to validate these findings.
Background:
Dipyridamole stress myocardial contrast echocardiography (MCE) can be used to detect coronary artery disease (CAD). Because it measures myocardial blood flow velocity in addition to measuring myocardial blood volume, it was hypothesized that it should have greater prognostic utility than single photon-emission computed tomography (SPECT), which measures only myocardial blood volume. Because blood flow mismatch precedes wall thickening (WT) abnormalities during demand ischemia, it was also postulated that perfusion on MCE would be superior to WT abnormalities on echocardiography for this purpose.
Methods:
The incidence of nonfatal myocardial infarction and cardiac death was determined in 261 patients with known or suspected CAD over a mean follow-up period of 14 months who underwent simultaneous dipyridamole stress MCE and 99mTc-sestamibi SPECT. Comparisons of survival curves were conducted with stratified (and unstratified) log-rank tests.
Results:
Abnormal results on MCE were found to be the best predictor of an adverse outcome (odds ratio, 23; 95% confidence interval, 6-201; P<.0001) and provided incremental prognostic value over clinical variables (age>60 years, the presence of >or=3 cardiac risk factors, known peripheral vascular disease, prior myocardial infarction, and left ventricular systolic function), inducible WT abnormalities, and SPECT. Prognoses were worst in patients who had both abnormal results on MCE and inducible WT abnormalities and best in those who had neither. Patients with abnormal results on MCE but no inducible WT abnormalities had intermediate outcomes.
Conclusion:
In patients with known or suspected CAD undergoing dipyridamole stress, MCE provides powerful prognostic information that is superior to clinical variables, electrocardiography, left ventricular systolic function, WT analysis, and SPECT. MCE may therefore serve as a method of choice for myocardial perfusion assessment in patients with known or suspected CAD. Larger studies are needed to confirm these findings.
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