Diagnostic Value Of Adenosine Stress Myocardial Contrast Echocardiography In Chronic Coronary Sydrome

BackgroundChronic coronary syndrome(CCS)covers different stages of development of coronary artery disease(CAD).Stress test is widely used abroad in diagnosis of CAD,but it has not been paid enough attention in our country.The safety and diagnostic value of adenosine injection are not clear in stress test.The prognostic value of adenosine stress myocardial contrast echocardiography(AS-MCE)in CCS needs to be further discussed.ObjectiveTo evaluate the safety of adenosine injection in clinical application in stress test,to evaluate the diagnostic value of AS-MCE in CCS by semi-quantitative method,and to explore the prognostic value of AS-MCE in CCS,so as to determine whether AS-MCE can be used as an independent predictor to guide clinical decision-making.Methods1.The side effects and hemodynamic changes of AS-MCE in 139 patients withsuspected CCS were analyzed.2.Fifty-eight patients who underwent AS-MCE examination and underwent coronary angiography(CAG)and coronary artery computed tomography angiography(CTA)within one month were selected.The results of AS-MCE were semi-quantitatively analyzed and compared with those of CAG and coronary artery CTA to evaluate the diagnostic value of AS-MCE in CCS.3.According to the results of AS-MCE,the patients were divided into normal AS-MCE group and abnormal AS-MCE group,and the influencing factors of AS-MCE results were analyzed.The clinical endpoint events were followed up by telephone or inpatient medical record system,and the influencing factors of terminal events were analyzed by COX regression to explore the prognostic value of AS-MCE in CCS.Primary endpoint included all-cause death,cardiovascular death,and non-fatal myocardial infarction,while secondary endpoints included hospitalization of angina pectoris and revascularization(PCI or CABG).Results1.33.8%(47/139)of the patients had varying degrees of side effects among the 139 patients,in which 33.1%of the patients experienced mild discomfort during adenosine infusion,which was tolerable without severe side effects.Meanwhile,the symptoms resolved spontaneously after withdrawal.The test was terminated due to severe adverse reactions in 0.7%(1/139)of the patients.In 138 patients who underwent AS-MCE successfully,the heart rate increased and blood pressure decreased at 3min after adenosine infusion,which recovered a little bit simultaneously after adenosine withdrawal,and there was significant difference between the two groups(P<0.05).During adenosine infusion,40.6%(56/138)patients showed varying degrees of ST-T changes,meanwhile,7.2%(10/138)patients showed atrioventricular block.2.Among the 58 patients,30 cases of AS-MCE were positive(51.7%),while CAG and coronary CTA were positive in 30 cases(51.7%),and the difference was not statistically significant(P>0.05).The diagnostic results of the two methods were consistent(Kappa=0.655,P=0.000).Compared with CAG and coronary CTA,and AS-MCE,the sensitivity,specificity,accuracy of diagnosing CCS were 83.3%,82.1%and 82.8%,respectively.3.Among the 138 patients who underwent AS-MCE successfully,there were 86 cases in normal AS-MCE group and 52 cases in abnormal group.AS-MCE abnormality was associated with hypertension,old myocardial infarction,statins,ARB,LVEDV,LVESV,LVMW and LVEF(P<0.05).The average follow-up was(417.3 ± 15.4)days.COX regression analysis showed that AS-MCE was a significant predictor of compound endpoint events(HR=6.311,P=0.001,95%CI:2.100-18.971),secondary composite endpoint events(HR=6.421,P=0.001,95%CI:2.130-19.358)and revascularization(HR=13.977,P=0.001,95%CI:3.161-61.801).The survival curve showed that the incidences of compound endpoint events,secondary composite endpoint events and revascularization events in the abnormal AS-MCE group were significantly higher than those in the normal AS-MCE group,whose P values were all less than 0.001.CONCLUSION1.There is low incidence of side effects of adenosine infusion in stress test,which it is safe and effective.2.Compared with anatomical imaging,AS-MCE has important diagnostic value in CCS with high sensitivity,specificity and accuracy,and it can be used to identify the presence of obstructive coronary artery disease in patients with CCS.3.AS-MCE is a significant predictor of clinical end-point events in patients with CCS,and patients with abnormal AS-MCE are more likely to have clinical end-point events.