Perfusion Abnormality in Adenosine Stress Myocardial Contrast Echocardiography in Intermediate-Risk Patients With...

In patients with intermediate-risk chest pain, a functional stress study is important for therapeutic strategies. However, many physicians encounter challenges in clinical decisions with biases of non-ischemic pain from resting-regional wall motion abnormality (RWMA) related to the prior myocardial scar. We aimed to use adenosine stress myocardial contrast echocardiography (MCE) to assess perfusion defects (PD) and predict cardiac events in these patients.

We retrospectively analyzed 496 patients, categorizing them into four groups based on resting-RWMA and PD on MCE. The study endpoint comprised coronary revascularization, worsening heart failure, and cardiac death.

Patients with severe RWMA and PD were older and exhibited a higher prevalence of diabetes, atrial fibrillation, heart failure, coronary artery disease, and coronary intervention. Their echocardiography revealed increased cardiac chamber dilation, lower left ventricular ejection fraction, and reduced tissue Doppler velocities. Over a median follow-up of 38 months, a study outcome occurred in 54 (11%) patients. Multivariate analysis indicated a 13-fold increase in outcomes among patients with PD and resting-RWMA ≥ 2 segments, respectively. PD ≥ 2 segments, rather than resting-RWMA, independently carried an increased outcome on adjusted Kaplan-Meier analysis.

PD could complement resting-RWMA and be a robust predictor of cardiac events in intermediate-risk patients.