title: Effect of intravenous contrast for left ventricular opacification and border definition on sensitivity and specificity of dobutamine stress echocardiography compared with coronary angiography in technically difficult patients.
abstract: BACKGROUND
  The study evaluates whether Optison used during dobutamine stress echocardiography (DSE) will improve endocardial border definition and whether this will translate to an improvement in sensitivity and specificity of the test in patients with poor echocardiographic windows. DSE is extremely valuable in the workup of patients with coronary artery disease. The test is limited in patients with suboptimal endocardial border visualization. Frequent studies have demonstrated improved endocardial border visualization with intravenous contrast agents at rest.
  
  
  RESULTS
  We studied 229 patients: 112 had good rest echocardiography with no contrast and 117 had poor rest echocardiography with Optison injection during DSE. Percentage of endocardial border visualization, wall thickening, sensitivity, and specificity were compared in both groups, as was interobserver variability. Both groups were matched with respect to age, percentage of previous myocardial infarctions, resting wall motion abnormality, percentage of coronary stenosis, and number of diseased coronary arteries. Optison significantly improved endocardial border visualization, especially at peak stress. The ability to measure wall thickening was significantly higher in the contrast DSE group with suboptimal images versus the noncontrast group with optimal images (89% ability to measure wall thickening vs 71%, P =.01). This resulted in a comparable sensitivity (79% vs 71%, P = not significant [NS]), specificity (76% vs 82%, P = NS), and diagnostic accuracy (80% vs 76%, P = NS). Agreement on test interpretation was higher among 3 observers in contrast DSE versus noncontrast DSE groups (79% vs 69%, P =.01).
  
  
  CONCLUSIONS
  In patients with poor echocardiographic windows, the use of Optison during DSE improves endocardial border visualization, which translates to a comparable sensitivity and specificity to noncontrast DSE tests in patients with good echocardiographic windows.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Saint Louis University, St Louis, MO, USA. melda@tetranet.net
authors.forename: M S
authors.initials: MS
authors.lastname: Dolan
authors.forename: K
authors.initials: K
authors.lastname: Riad
authors.forename: A
authors.initials: A
authors.lastname: El-Shafei
authors.forename: S
authors.initials: S
authors.lastname: Puri
authors.forename: K
authors.initials: K
authors.lastname: Tamirisa
authors.forename: M
authors.initials: M
authors.lastname: Bierig
authors.forename: J
authors.initials: J
authors.lastname: St Vrain
authors.forename: L
authors.initials: L
authors.lastname: McKinney
authors.forename: E
authors.initials: E
authors.lastname: Havens
authors.forename: K
authors.initials: K
authors.lastname: Habermehl
authors.forename: L
authors.initials: L
authors.lastname: Pyatt
authors.forename: M
authors.initials: M
authors.lastname: Kern
authors.forename: A J
authors.initials: AJ
authors.lastname: Labovitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D004280:Dobutamine / Q000008:administration & dosage; D004452:Echocardiography / Q000706:statistics & numerical data; D005080:Exercise Test / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D016276:Ventricular Function
chemical_list: D004280:Dobutamine