Contrast-Enhanced Stress Echocardiography and Myocardial Perfusion Imaging in Patients Hospitalized With Chest Pain: A Randomized Study. Issue 2 (June 2018)

• Record Type: Journal Article
• Authors: Salame, Gerald; Juselius, Whitney E.; Burden, Marisha; Long, Carlin S.; Bendelow, Tiffany; Beaty, Brenda; Masoudi, Frederick A.; Krantz, Mori J.
• Is Part Of: Critical pathways in cardiology. Volume 17:Issue 2(2018)
• Publication Date: 2018-06
• Subjects: comparative effectiveness -- contrast enhancement -- coronary artery disease -- myocardial perfusion imaging -- single photon emission computed tomography -- stress echocardiography -- stress testing; Cardiology -- Periodicals; Evidence-based medicine -- Periodicals; Medical protocols -- Periodicals; 616.12005
• DOI: 10.1097/HPC.0000000000000141
• Languages: English
• ISSNs: 1535-282X

Abstract

Abstract : Ultrasound contrast-enhanced stress echocardiography improves endocardial visualization, but diagnostic test rates versus stress myocardial perfusion imaging (MPI) have not been studied. A prospective randomized trial was performed between April 2012 and October 2014 at a single-center, safety net hospital. Hospitalized patients referred for noninvasive stress imaging were randomized 1:1 to stress echocardiography or stress MPI. The primary outcome was diagnostic test rate defined as interpretable images and achievement of >85% of age-predicted maximal heart rate (for dobutamine and exercise). Rates were assessed among those completing testing and then based solely on image interpretability. Charges and length of stay were secondary outcomes. A total of 240 patients were randomized, and 229 completed testing. Diagnostic test rates were similar for stress echocardiography versus MPI {89.4% [95% confidence interval (CI), 82.2–94.4] vs. 94.8% [95% CI, 89.1–98.1], P = 0.13} and did not differ with multivariable adjustment. Modalities requiring a diagnostic heart rate criteria were more frequently ordered with stress echocardiography (100% vs. 26%; P < 0.001). Therefore, an imaging-based analysis without the 12 individuals who failed to achieve target heart rate (n = 217) was evaluated with diagnostic test rates of 100% versus 94.8% (95% CI, 89.1%–98.1%; P = 0.03) for stress echocardiography and MPI, respectively. Median length of stay did not differ. Median (interquartile range) test-related charges were lower with stress echocardiography: $2, 424 ($2400–$2508) versus $3619 ($3584–$3728), P < 0.0001. Overall, tests were positive for ischemia in 8% of patients. In conclusion, contrast-enhanced stress echocardiography provides comparable diagnostic test rates to MPI with lower associated charges.