title: Assessment of myocardial perfusion by harmonic power Doppler imaging at rest and during adenosine stress: comparison with (99m)Tc-sestamibi SPECT imaging.
abstract: BACKGROUND
  Harmonic power Doppler imaging (HPDI) is a novel technique for assessing myocardial perfusion by contrast echocardiography in humans. The purpose of this study was to compare myocardial perfusion by HPDI with that obtained by (99m)Tc-sestamibi single photon emission computed tomography (SPECT) during rest and pharmacological stress.
  
  
  RESULTS
  HPDI was performed on 123 patients who were referred for SPECT imaging for known or suspected coronary artery disease. Images were obtained at baseline and during adenosine infusion (0.14 mg. kg(-)(1). min(-)(1)x6 minutes) in 3 apical views. Myocardial perfusion by HPDI was graded for each coronary territory as absent, patchy, or full. The persistence of absent or patchy myocardial perfusion by HPDI between rest and adenosine was interpreted as a fixed defect, whereas any decrease in perfusion grade was interpreted as a reversible defect. Overall concordance between HPDI and SPECT was 83 (81%) of 103 for normal versus abnormal perfusion. Agreement between the 2 methods for each of the 3 coronary territories was 81% (kappa=0.57) for the left anterior descending artery, 76% (kappa=0.52) for the right coronary artery, and 72% (kappa=0.40) for the left circumflex artery. Discrepancies between the 2 techniques were most notable in the circumflex territory, where fixed defects were observed in 33% by HPDI but in only 14% by SPECT (chi(2)=15.8, P=0.0001).
  
  
  CONCLUSIONS
  This study demonstrates that HPDI can reliably detect myocardial perfusion during pharmacological stress, although there was a significantly higher number of falsely abnormal results in the circumflex territory.
authors.affiliation: Department of Internal Medicine, UT Southwestern and Dallas VA Medical Centers, TX 75216, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Heinle
authors.forename: J
authors.initials: J
authors.lastname: Noblin
authors.forename: P
authors.initials: P
authors.lastname: Goree-Best
authors.forename: A
authors.initials: A
authors.lastname: Mello
authors.forename: G
authors.initials: G
authors.lastname: Ravad
authors.forename: S
authors.initials: S
authors.lastname: Mull
authors.forename: P
authors.initials: P
authors.lastname: Mammen
authors.forename: P A
authors.initials: PA
authors.lastname: Grayburn
mesh_terms: D000241:Adenosine; D000368:Aged; D002637:Chest Pain / Q000000981:diagnostic imaging; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D015150:Echocardiography, Doppler / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D019275:Radiopharmaceuticals; D012015:Reference Standards; D012146:Rest; D013312:Stress, Physiological / Q000139:chemically induced; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods / Q000592:standards*; D014665:Vasodilator Agents
chemical_list: D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D017256:Technetium Tc 99m Sestamibi; D000241:Adenosine