Effect of coronary revascularization on the prognostic value of stress myocardial contrast wall motion and perfusion imaging

Background-the assessment of myocardial perfusion (mp) and wall motion (wm) using contrast dipyridamole echocardiography (cse-wmp) improves the sensitivity to detect coronary artery disease and the stratification of cardiac events,but its long-term value for fatal and nonfatal ischemic cardiac events,also with respect to patients undergoing revascularization or not,remains to be determined. methods and results-one-thousand three-hundred and twenty-nine patients with suspect or known cad who underwent csewmp were followed for a median 5.5 years. the independent prognostic value of cse-wmp regarding cardiac death or nonfatal myocardial infarction was related to stress wm and mp,rest ejection fraction,clinical risk factors,and medications. patients revascularized after cse-wmp were separately analyzed to determine whether the procedure influenced outcome and whether this depends on cse-wmp results. a total of 125 cardiac fatal and nonfatal ischemic events (9.4%) occurred during the follow-up (61 deaths,64 myocardial infarctions). the 5-year event rate with normal mp and wm was 5.9%,9.9% with isolated mp defects (normal wm),and 15.5% with both mp and wm abnormalities. in patients not undergoing revascularization (n = 1111),reversible mp defects added discrimination value over wm response and clinical factors/medication data (p = 0.001),while in the cohort undergoing revascularization (n = 218),cse-wmp results did not influence outcome. conclusions-cse-wmp,with both contrast mp and wm assessments,provides independent,incremental prognostic information regarding ischemic cardiac events at 5 years in patients with known or suspected coronary artery disease. revascularization reduces cardiac events after an abnormal cse-wmp,resulting in outcomes not different from those in patients with normal cse-wmp. © 2017 the authors.