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Prognostic value of real time dobutamine stress myocardial contrast echocardiography in patients with chest pain syndrome

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Abstract

The aims of this study were (1) to evaluate the prognostic value of negative wall motion (WM) and myocardial perfusion during contrast-dobutamine stress echocardiography (DSE), (2) to determine whether WM-myocardial contrast echocardiography (MCE) had incremental prognostic value over just WM during DSE in patients with chest pain in the emergency room (ER), and (3) to compare the prognostic value of negative DSE-WM, and DSE-WM-MCE to nuclear-myocardial perfusion imaging (N-MPI) in a similar patient population over the same time period. We retrospectively studied 569 patients with real time contrast DSE, and 147 patients underwent N-MPI for evaluation of chest pain. Follow-up for cardiac events was obtained between 12 and 25 months. The cumulative cardiac event-free survival was 94.5% in negative DSE-WM, 97.1% in negative DSE-WM-MCE and 96.7% in negative N-MPI group. Cardiac event-free survival of the negative DSE-WM-MCE group was significantly higher than the DSE-WM group (log rank P < 0.01), and similar in the DSE-WM-MCE group compared to the N-MPI group. Combined WM and perfusion during DSE was the strongest independent predictor for cardiac events. The negative predictive power of DSE-WM-MCE is superior to that of just negative DSE-WM and is comparable to that of N-MPI. Myocardial perfusion and WM analysis during DSE provide independent information for predicting cardiac events in patients with chest pain syndrome in the ER.

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Abbreviations

DSE:

Dobutamine stress echocardiography

N-MPI:

Nuclear myocardial perfusion imaging

ER:

Emergency room

ECG:

Electrocardiogram

NPV:

Negative predictive value

WM:

Wall motion

MCE:

Myocardial contrast echocardiography

CAD:

Coronary artery disease

FRS:

Framingham risk score

LVO:

Left ventricular opacification

SPECT:

Single photon emission computed tomography

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Acknowledgments

This research was supported by the Yeungnam University research grants in 2008 (208-A-235-125).

Conflict of interest

Mani Vannan—Research and Honorarium Support from Siemens and Bristol Myers Squibb Medical Imaging.

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Authors and Affiliations

  1. Division of Cardiology, Yeungnam University College of Medicine, Daegu, Korea

    Geu-Ru Hong, Jong-Seon Park, Sang-Hee Lee, Dong-Gu Shin & Ung Kim

  2. Division of Cardiology, Pusan National University School of Medicine, Busan, Korea

    Jung Hyun Choi

  3. Division of Cardiology, Department of Medicine, University of California, Irvine Medical Center, Orange, CA, USA

    Robin Abdelmalik, Jesús A. Vera, Jin-Kyung Kim & Jagat Narula

  4. Division of Cardiovascular Medicine, The Ohio State University Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH, 43210-1252, USA

    Mani A. Vannan

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  1. Geu-Ru Hong
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Correspondence to Mani A. Vannan.

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Hong, GR., Park, JS., Lee, SH. et al. Prognostic value of real time dobutamine stress myocardial contrast echocardiography in patients with chest pain syndrome. Int J Cardiovasc Imaging 27 (Suppl 1), 103–112 (2011). https://doi.org/10.1007/s10554-011-9976-1

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