Is 3D Dobutamine stress echocardiography ready for prime time? Diagnostic and prognostic implications. (23rd June 2019)

• Record Type: Journal Article
• Authors: Shivalkar, Bharati; De Keersmaeker, Alexander; Van Hoeck, Nathan; Belkova, Petra; Van de Heyning, Caroline M; De Maeyer, Catherine; Vrints, Christiaan
• Is Part Of: European heart journal. Volume 21:Number 4(2020)
• Page Start: 428
• Page End: 436
• Publication Date: 2019-06-23
• Subjects: 3D-echocardiography -- Dobutamine stress echocardiography -- contrast enhanced echocardiography -- prognostic value; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jez161
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: 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.