Dual imaging stress echocardiography versus computed tomography coronary angiography for risk stratification of patients with chest pain of unknown origin

Cardiovascular Ultrasound

Research

Eugenio Picano¹  Fausto Rigo²  Elisabetta Grolla²  Quirino Ciampi³  Lauro Cortigiani⁴ 

[1] CNR Institute of Clinical Physiology, Pisa, Italy;Department of Cardiology, dell’Angelo Hospital, Mestre-Venice, Italy;Division of Cardiology, Fatebenefratelli Hospital, Viale Principe di Napoli, 12 I-82100, Benevento, Italy;CNR Institute of Clinical Physiology, Pisa, Italy;Division of Cardiology, Lucca Hospital, Lucca, Italy;

关键词: Coronary flow reserve;    Computed tomography coronary angiography;    Coronary artery disease;   

DOI  :  10.1186/s12947-015-0013-8

 received in 2015-02-23, accepted in 2015-04-01,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundDual imaging stress echocardiography, combining the evaluation of wall motion and coronary flow reserve (CFR) on the left anterior descending artery (LAD), and computed tomography coronary angiography (CTCA) are established techniques for assessing prognosis in chest pain patients. In this study we compared the prognostic value of the two methods in a cohort of patients with chest pain having suspected coronary artery disease (CAD).MethodsA total of 131 patients (76 men; age 68 ± 9 years) with chest pain of unknown origin underwent dipyridamole (up to 0.84 mg/kg over 6 min) stress echo with CFR assessment of LAD by Doppler and CTCA. A CFR ≤ 1.9 was considered abnormal, while > 50% lumen diameter reduction was the criterion for significant CAD at CTCA.ResultsOf 131 patients, 34 (26%) had ischemia at stress echo (new wall motion abnormalities), and 56 (43%) had reduced CFR on LAD. Significant coronary stenosis at CTCA was found in 69 (53%) patients. Forty-six patients (84%) with abnormal CFR on LAD showed significant CAD at CTCA (p < 0.001). Calcium score was higher in patients with reduced than in those with normal CFR (265 ± 404 vs 131 ± 336, p = 0.04). During a median follow-up of 7 months (1st to 3rd quartile: 5–13 months), there were 45 major cardiac events (4 deaths, 11 nonfatal myocardial infarctions, and 30 late [≥6 months] coronary revascularizations). At Cox analysis, independent prognostic indicators were calcium score > 100 (HR 2.84, 95% CI 1.33-6.07, p = 0.007), significant CAD at CTCA (HR 2.68, 95% CI 1.23-5.82, p = 0.013), and inducible ischemia or CFR <1.9R on LAD on dual imaging stress echo (HR 2.25, 95% CI 1.05-4.84, p = 0.038).ConclusionsFunctional and anatomical evaluation using, respectively, dual imaging stress echocardiography and CTCA are both effective modalities to risk stratify patients with chest pain of unknown origin, yielding independent and comparable prognostic value. Compared to CTCA, however, stress echocardiography has the advantage of lower cost and of being free of radiations.

【 授权许可】

CC BY   
© Ciampi et al.; licensee BioMed Central. 2015