This article is more than 5 years old. Information may no longer be current.
Real-time perfusion imaging more beneficial to men without known CAD
In men without known CAD, the addition of perfusion imaging to real-time myocardial contrast echocardiography appears to improve prognostic capability compared with conventional stress echocardiography, according to recent findings. However, a similar predictive improvement was not observed in age-matched women.
For a prospective, randomized trial, researchers evaluated 1,649 consecutive patients seen at the University of Nebraska Medical Center echocardiography laboratory from October 2007 to October 2011 (mean age, 58 ± 13 years). Participants were randomly assigned to undergo conventional stress echocardiography (CSE; 367 men, 485 women) or real-time myocardial contrast echocardiography (RTMCE; 350 men, 438 women). All patients underwent stress testing via treadmill exercise or dobutamine.
The primary outcome was difference in event-free survival between men and women according to echocardiography results. Events were defined as time to death, nonfatal MI or later surgical or percutaneous revascularization during a median follow-up of 2.6 years.
Follow-up data were available for 1,596 patients. Overall, there were 62 deaths, 12 nonfatal MIs and 85 revascularizations, with a 2-year event rate of 3.5%. Male gender was significantly predictive of adverse outcomes in the CSE and RTMCE groups (HR = 2.07; 95% CI, 1.07-4.02 for conventional echocardiography; HR = 2.14; 95% CI, 1.04-4.33 for RTMCE).
Among patients with normal results from CSE, men had higher subsequent 2-year event rates compared with women (5.4% vs. 1.6%; P = .02); however, this difference was not observed among patients with normal RTMCE results (5.8% among men vs. 3.7% among women; P = .41). Men with abnormal RTMCE results had significantly higher event rates compared with women (34.8% vs. 16.4%; P = .02). However, there were no disparities in outcome according to gender after abnormal results from CSE (17.8% among men vs. 18.6% among women; P = .9).
According to the researchers, additional studies are warranted to ascertain the added prognostic potential of RTMCE over CSE in women with higher pretest probability, including older women or those with known CAD.
“This study may help clinicians in deciding when a real-time stress echo perfusion study may be helpful in a woman with symptoms suggestive of CAD,” the researchers wrote. “Pretest probability may play a significant role in predicting when real-time perfusion imaging during stress has added predictive value.”
Disclosure: Lantheus Medical Imaging provide support for the study. One researcher reports receiving grant support from Astellas Pharma, General Electric Global Research, Lantheus Medical Imaging and Phillips Research North America, along with educational support from Bracco Research.