To assess the value of stress echocardiography combined with myocardial contrast echocardiography in evaluating adverse cardiovascular events in patients with suspected or diagnosed coronary heart disease.

A total of 361 patients with suspected or confirmed coronary heart disease who underwent stress echocardiography combined with myocardial contrast echocardiography from February 2014 to September 2020 at the Department of Cardiology, Nanfang Hospital, Southern Medical University were retrospectively included. According to the results of stress echocardiography, the patients were divided into either a normal group (260 cases) or an abnormal group (101 cases). Adverse cardiovascular endpoints (the primary endpoints included all-cause death, cardiovascular death, and nonfatal myocardial infarction, and the secondary endpoints included hospitalization for angina pectoris and revascularization) were followed, and the incidence of adverse events was compared between the abnormal group and normal group. Cox regression analysis and Kaplan-Meier survival analysis were used performed to indentify the predictors of endpoint events and calculate the 2-year and 5-year survival rates without major cardiovascular adverse events, respectively.

The 361 patients were followed up for an average of (41.05±22.50) months. The primary endpoint event occurred in 7 patients, hospitalization for angina pectoris occurred in 39, and revascularization was performed in 55. Two patients in the normal group had a primary endpoint event, and 36 had a secondary endpoint event; 5 patients in the abnormal group had a primary endpoint event, and 41 patients had a secondary endpoint event. There was a statistically significant difference in the incidence of adverse events between the two groups (P＜0.001). Multivariate analysis using a Cox proportional hazard model showed that stress echocardiography (hazard ratio=0.354, 95% confidence interval: 0.221~0.569, P＜0.001) was one of the predictors of the endpoints. Kaplan-Meier survival analysis showed that the 2-year and 5-year survival rates without major adverse cardiovascular events were 96.2% and 84.9% in the normal group, and 93.8% and 66.2% in the abnormal group, respectively. The difference in survival curves between the two groups was statistically significant (P＜0.001).

Stress echocardiography plays an important role in the diagnosis of coronary artery disease, risk stratification, and guidance of revascularization, and can be used as an important means for prognosis evaluation of patients with suspected or confirmed coronary heart disease.