Key result
Stress-positive 2D-LVO and 3D-LVO dobutamine stress echocardiography predicted late major adverse cardiovascular events versus stress-negative patients (OR 7.07; 95% CI 1.62-25.16; P=0.001).
Why the study?
The study was conducted to compare the diagnostic accuracy and prognostic value of echo contrast enhanced 2D and 3D Dobutamine stress echocardiography.
Does contrast enhanced 3D Dobutamine stress echocardiography improve diagnostic accuracy and prognostic value compared to 2D DSE in patients indicated for stress testing?
Cohort (n=718)
Does contrast enhanced 3D Dobutamine stress echocardiography improve diagnostic accuracy and prognostic value compared to 2D DSE in patients indicated for stress testing?
Odds Ratio: 7.07 (95% CI 1.62–25.16)
p-value: p=0.001
The combined use of 2D- and 3D-LVO Dobutamine stress echocardiography improves diagnostic accuracy and prognostic value for predicting MACE in patients undergoing stress testing.
Supports incorporating 3D left ventricular opacification into routine stress echocardiography for enhanced risk stratification.
AIMS: Compare the diagnostic accuracy and prognostic value of echo contrast enhanced 2D and 3D Dobutamine stress echocardiography (DSE). METHODS AND RESULTS: We included 718 patients indicated for DSE. All had standard 2D, and contrast enhanced left ventricular opacification (LVO) for 2D and 3D acquisitions at rest and peak stress. Chi-square test was done to assess relationship between DSE result and early revascularization. Kaplan-Meier plots with Logistic regression analysis predicted late major adverse cardiovascular events (MACE) at a maximum follow-up of 84 months. The mean age was 63 ± 13 years (61% males) and follow-up was obtained in 692/718 (96.4%) patients. Only 32% had excellent baseline image quality. The DSE was abnormal in 19.4% patients on 2D, in 17.1% on 2D-LVO and in 19.1% on 3D-LVO. Early revascularization was performed in, respectively, 32.8%, 45.8%, and in 48.5% of stress-positive 2D, 2D-LVO, and 3D-LVO studies. After excluding the 66 patients receiving early revascularization 68/626 (10.9%) had MACE at a maximum follow-up of 84 months. Kaplan-Meier plots showed that stress-positive 2D-LVO and 3D-LVO studies not receiving early revascularization when assessed separately and combined had significantly worse outcomes for MACE compared with stress-negative patients (OR 3.69; 95% CI: 1.54-8.87; P = 0.011, OR 4.54; 95% CI: 1.72-12.93; P = 0.008, and OR 7.07, 95% CI: 1.62-25.16; P = 0.001, respectively). CONCLUSION: Combined use of 2D- and 3D-LVO DSE is ready for prime time considering the feasibility, improved diagnostic accuracy and prognostic value.
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Shivalkar et al. (2019) conducted a cohort in Indication for Dobutamine stress echocardiography (n=718). 2D-LVO and 3D-LVO Dobutamine stress echocardiography vs. Stress-negative patients was evaluated on Late major adverse cardiovascular events (MACE) (OR 7.07, 95% CI 1.62-25.16, p=0.001). Stress-positive 2D-LVO and 3D-LVO dobutamine stress echocardiography predicted late major adverse cardiovascular events versus stress-negative patients (OR 7.07; 95% CI 1.62-25.16; P=0.001).
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