Author + information
- Received January 24, 2013
- Revision received April 11, 2013
- Accepted April 16, 2013
- Published online June 18, 2013.
- Thomas R. Porter, MD∗∗ (, )
- Lynette M. Smith, MS†,
- Juefei Wu, MD∗,
- Deepak Thomas, MD∗,
- John T. Haas, MD∗,
- Daniel H. Mathers, MD∗,
- Eric Williams, MD∗,
- Joan Olson, RDCS∗,
- Kevin Nalty, RN∗,
- Roberta Hess, RN∗,
- Stacey Therrien, BS∗ and
- Feng Xie, MD∗
- ∗Department of Cardiology, Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
- †College of Public Health Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
- ↵∗Reprint requests and correspondence:
Dr. Thomas R. Porter, Division of Cardiology, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, Nebraska 68198.
Objectives 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.
This study was supported in part by Lantheus Medical and the Theodore Hubbard Foundation. Dr. Porter has received grant support from General Electric Global Healthcare, Astellas Pharma, Inc., Lantheus Medical Imaging, and Philips Healthcare; and equipment support from Philips Healthcare and GE Global Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 24, 2013.
- Revision received April 11, 2013.
- Accepted April 16, 2013.
- 2013 American College of Cardiology Foundation