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Study examined predictive value of two types of echocardiography
LOS ANGELES — Real-time myocardial contrast echocardiography more frequently detected abnormal studies in patients with suspected CAD, but was no better at predicting event-free survival than conventional stress echocardiography, according to data presented by Thomas R. Porter, MD.
The data come from a study of more than 2,000 patients with intermediate pre-test probability undergoing dobutamine or exercise stress echocardiography who were randomly assigned real-time myocardial contrast echocardiography (RTMCE) or conventional stress echocardiography (CSE).
Findings show that abnormal RTMCE studies were more often detected than abnormal CSE studies (P<.001), and more often in a multivessel territory (P<.005). Patients with abnormal RTMCE studies were more likely to require revascularization than abnormal CSE studies.
However, event-free survival in patients with positive or negative studies did not differ between RTMCE and CSE.
The RTMCE group had a higher proportion of patients with prior MI and prior PCI, said Porter, from the University of Nebraska Medical Center.
All studies were interpreted immediately by an expert reviewer in perfusion imaging (n=1,257) or a reviewer with basic training in perfusion imaging (n=806). The predictive value of stress echocardiography with contrast was improved with more experienced contrast users.
“Reviewer experience is critical for the optimal use of contrast, independent of whether it is being utilized for conventional imaging or RTMCE,” Porter said.
The study utilized continuous IV microbubble infusion (Definitely, Lantheus Medical) for all RTMCE studies to examine both myocardial perfusion and wall motion. The same method was used for CSE only when endocardial border delineation was inadequate (>60% of studies), according to the study abstract.
The mean age of patients in the study was 59 years and 53% were women. Those assigned RTMCE had a slightly lower ejection fraction and higher frequency of prior revascularization at baseline.
Overall, Porter noted that institutional biases may have played a role in outcome.
For more information:
Porter TR. Late-breaking clinical trials: Health economics and quality of life in contemporary trials. Presented at: the American Heart Association Scientific Sessions; Nov. 3-7, 2012; Los Angeles.
Disclosure: Porter reports grant support and/or equipment support from Astellas Pharma, GE Global Healthcare, Lantheus Medical Imaging, NuvOx Pharma and Philips Healthcare.