Prognostic Value of Qualitative and Quantitative Vasodilator Stress Myocardial Perfusion Echocardiography in Patients with Known or Suspected Coronary Artery Disease

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorMATTOSO, Angele A. A.
dc.contributor.authorKOWATSCH, Ingrid
dc.contributor.authorTSUTSUI, Jeane M.
dc.contributor.authorCRUZ, Victoria Yezinia de la
dc.contributor.authorRIBEIRO, Henrique B.
dc.contributor.authorSBANO, Joao C. N.
dc.contributor.authorRAMIRES, Jose A. F.
dc.contributor.authorKALIL FILHO, Roberto
dc.contributor.authorPORTER, Thomas R.
dc.contributor.authorMATHIAS JR., Wilson
dc.date.accessioned2013-09-23T16:36:33Z
dc.date.available2013-09-23T16:36:33Z
dc.date.issued2013
dc.description.abstractBackground: Quantification of myocardial blood flow reserve in patients with coronary artery disease using real-time myocardial perfusion echocardiography (RTMPE) has been demonstrated to further improve accuracy over the analysis of wall motion and qualitative analysis of myocardial perfusion. The aim of this study was to determine the prognostic value of qualitative and quantitative analyses obtained by RTMPE in patients with known or suspected coronary artery disease. Methods: From March 2003 to December 2008, 227 consecutive patients with normal left ventricular function who underwent RTMPE were prospectively studied. Replenishment velocity reserve (beta) and myocardial blood flow reserve were derived from RTMPE. Primary outcomes were cardiac death, myocardial infarction and unstable angina with need for urgent coronary revascularization, and secondary outcomes were coronary bypass graft surgery or angioplasty. Results: During a median follow-up period of 32 months (range, 5 days to 6.9 years), 19 major events (two deaths, six myocardial infarctions, and 11 episodes of unstable angina) and 46 total events occurred. Wall motion (hazard ratio [HR], 2.8; 95% confidence interval [CI], 1.4-5.6; P = .003) and qualitative myocardial perfusion analysis (HR, 4.3; 95% CI, 2.1-8.5; P < .001) were predictors of total events but not primary events. Abnormal myocardial blood flow reserve and abnormal b reserve were predictors of total events (HR, 8.1; 95% CI, 3-21; P < .001; and HR, 16.5; 95% CI, 5.5-49; P < .001) and primary events (HR, 3.8; 95% CI, 1-15; P = .048; and HR, 8.7; 95% CI, 1.8-40; P = .005). On multivariate analysis, only abnormal b reserve was an independent predictor of total (HR, 10.6; 95% CI, 2.5-43; P = .001) and primary (HR, 10.5; 95% CI, 1.5-6; P = .015) events. Abnormal b reserve added incremental value in predicting primary events (chi(2) = 2.0-13.2; P = .014). Conclusions: Quantitative adenosine stress RTMPE added independent and additional prognostic information over wall motion and qualitative myocardial perfusion analysis in patients with known or suspected coronary artery disease and normal left ventricular function.
dc.description.indexMEDLINE
dc.description.sponsorshipFundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)
dc.identifier.citationJOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, v.26, n.5, p.539-547, 2013
dc.identifier.doi10.1016/j.echo.2013.01.016
dc.identifier.issn0894-7317
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/1807
dc.language.isoeng
dc.publisherMOSBY-ELSEVIER
dc.relation.ispartofJournal of the American Society of Echocardiography
dc.rightsrestrictedAccess
dc.rights.holderCopyright MOSBY-ELSEVIER
dc.subjectCoronary artery disease
dc.subjectMyocardial perfusion
dc.subjectPrognostic value
dc.subject.otheremission computed-tomography
dc.subject.othercontrast echocardiography
dc.subject.otherblood-flow
dc.subject.otherpharmacological stress
dc.subject.otherwall-motion
dc.subject.otherdobutamine
dc.subject.otherdipyridamole
dc.subject.otherreserve
dc.subject.otherquantification
dc.subject.othermicrobubbles
dc.subject.wosCardiac & Cardiovascular Systems
dc.titlePrognostic Value of Qualitative and Quantitative Vasodilator Stress Myocardial Perfusion Echocardiography in Patients with Known or Suspected Coronary Artery Disease
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.affiliation.countryEstados Unidos
hcfmusp.affiliation.countryisous
hcfmusp.author.externalMATTOSO, Angele A. A.:Univ Sao Paulo, Sch Med, Heart Inst InCor, BR-05403000 Sao Paulo, Brazil
hcfmusp.author.externalKOWATSCH, Ingrid:Fleury Grp, Sao Paulo, Brazil
hcfmusp.author.externalTSUTSUI, Jeane M.:Fleury Grp, Sao Paulo, Brazil
hcfmusp.author.externalCRUZ, Victoria Yezinia de la:Fleury Grp, Sao Paulo, Brazil
hcfmusp.author.externalPORTER, Thomas R.:Univ Nebraska Med Ctr, Omaha, NE USA
hcfmusp.citation.scopus20
hcfmusp.contributor.author-fmusphcHENRIQUE BARBOSA RIBEIRO
hcfmusp.contributor.author-fmusphcJOAO CESAR NUNES SBANO
hcfmusp.contributor.author-fmusphcJOSE ANTONIO FRANCHINI RAMIRES
hcfmusp.contributor.author-fmusphcROBERTO KALIL FILHO
hcfmusp.contributor.author-fmusphcWILSON MATHIAS JUNIOR
hcfmusp.description.beginpage539
hcfmusp.description.endpage547
hcfmusp.description.issue5
hcfmusp.description.volume26
hcfmusp.origemWOS
hcfmusp.origem.pubmed23484435
hcfmusp.origem.scopus2-s2.0-84876718891
hcfmusp.origem.wosWOS:000318906400013
hcfmusp.publisher.cityNEW YORK
hcfmusp.publisher.countryUSA
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