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European Heart Journal Advance Access originally published online on November 6, 2007
European Heart Journal 2008 29(3):377-385; doi:10.1093/eurheartj/ehm445
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007.For permissions please email: journals.permissions@oxfordjournals.org

Real-time dobutamine stress myocardial perfusion echocardiography predicts outcome in the elderly

Jeane M. Tsutsui1, Feng Xie1, David Cloutier2, Saul Kalvaitis1, Abdou Elhendy3 and Thomas R. Porter1,*

1 Section of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, NE 68198-2265, USA
2 Creighton University Medical Center, Omaha, Nebraska, USA
3 Department of Cardiology, Marshfield Clinic, Marshfield, WI, USA

Received 29 March 2007; revised 31 July 2007; accepted 13 September 2007; online publish-ahead-of-print 6 November 2007.

* Corresponding author. Tel: +1 402 559 7977, Fax: +1 402 5598355. Email: trporter{at}unmc.edu

See page 288 for the editorial comment on this article (doi:10.1093/eurheartj/ehm639)

Aims: Although there is an increasing number of studies showing the value of perfusion imaging with real-time contrast echocardiography (RTCE) for detecting coronary artery disease (CAD), no data exist regarding the value of this technique for detecting CAD and predicting outcome in the elderly.

Methods and results: We examined the outcome of 399 patients ≥70 years old who underwent dobutamine stress RTCE for known or suspected CAD. Myocardial perfusion imaging (MPI) was performed using low mechanical index pulse sequence schemes following intravenous small bolus injections of ultrasound contrast. Quantitative coronary angiography (QCA) was performed within 1 month of the stress test in 60 patients. Events were defined as cardiac death or non-fatal myocardial infarction (MI). Sensitivity of MPI for detecting CAD by QCA was 94% [confidence interval (CI) 91–99], specificity was 67% (CI 36–74), and accuracy was 90% (CI 82–95). During a median follow-up of 21 months, 46 events occurred (31 cardiac deaths, 15 non-fatal MI). Univariate predictors of outcome were diuretic use (P = 0.03), abnormal stress wall motion (P < 0.0001), and abnormal stress MPI (P < 0.0001). Abnormal stress MPI, however, was the most significant predictor of outcome ({chi}2 7.5; P = 0.006).

Conclusion: Myocardial perfusion analysis during dobutamine stress RTCE provides incremental predictive value in determining the outcome of elderly patients being evaluated for the presence of CAD.

Key Words: Myocardial contrast echocardiography • Prognosis • Coronary artery disease • Elderly


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