Key result
Perfusion defects on stress MCE are linked to a ~13-fold increase in cardiac events.
Why the study?
Physicians face decision-making challenges in intermediate-risk chest pain due to non-ischemic pain biases from resting-regional wall motion abnormality related to prior myocardial scar.
Does adenosine stress myocardial contrast echocardiography predict cardiac events in patients with intermediate-risk chest pain?
Cohort (n=496)
Does adenosine stress myocardial contrast echocardiography predict cardiac events in patients with intermediate-risk chest pain?
Effect estimate: 13-fold increase
Perfusion defects assessed by adenosine stress myocardial contrast echocardiography independently predict cardiac events in intermediate-risk patients with chest pain, complementing resting wall motion abnormalities.
May aid risk stratification in intermediate chest pain; hypothesis-generating and requires randomized trials before practice change.
PURPOSE: In patients with intermediate-risk chest pain, a functional stress study is important for therapeutic strategies. However, many physicians encounter challenges in clinical decisions with biases of non-ischemic pain from resting-regional wall motion abnormality (RWMA) related to the prior myocardial scar. We aimed to use adenosine stress myocardial contrast echocardiography (MCE) to assess perfusion defects (PD) and predict cardiac events in these patients. METHODS: We retrospectively analyzed 496 patients, categorizing them into four groups based on resting-RWMA and PD on MCE. The study endpoint comprised coronary revascularization, worsening heart failure, and cardiac death. RESULTS: Patients with severe RWMA and PD were older and exhibited a higher prevalence of diabetes, atrial fibrillation, heart failure, coronary artery disease, and coronary intervention. Their echocardiography revealed increased cardiac chamber dilation, lower left ventricular ejection fraction, and reduced tissue Doppler velocities. Over a median follow-up of 38 months, a study outcome occurred in 54 (11%) patients. Multivariate analysis indicated a 13-fold increase in outcomes among patients with PD and resting-RWMA ≥ 2 segments, respectively. PD ≥ 2 segments, rather than resting-RWMA, independently carried an increased outcome on adjusted Kaplan-Meier analysis. CONCLUSION: PD could complement resting-RWMA and be a robust predictor of cardiac events in intermediate-risk patients.
No takes yet. Share an insight, caveat, or question.
Kim et al. (2025) conducted a cohort in Intermediate-risk chest pain (n=496). Perfusion defects on adenosine stress myocardial contrast echocardiography vs. Absence of perfusion defects was evaluated on Coronary revascularization, worsening heart failure, and cardiac death (13-fold increase). Perfusion defects ≥ 2 segments on adenosine stress MCE independently predicted a 13-fold increase in cardiac events in patients with intermediate-risk chest pain.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: