Correlation between myocardial perfusion abnormalities detected with intermittent imaging using intravenous perfluorocarbon microbubbles and radioisotope imaging during high-dose dipyridamole stress echo.
BACKGROUND
The clinical accuracy of myocardial contrast echocardiography (MCE) using intermittent harmonic imaging and intravenous perfluorocarbon containing microbubbles during dipyridamole stress has not been evaluated in a multicenter setting.


OBJECTIVE
The accuracy of dipyridamole stress contrast echo in the detection of coronary artery disease (CAD) using myocardial perfusion images is high in comparison with technetium-99 (99Tc) sestamibi single-photon emission computed tomography (MIBI SPECT) and increases the accuracy of wall motion data.


METHODS
In 68 consecutive nonselected patients (46 men; mean age 66 years) from three different institutions in two countries. dipyridamole stress echo and SPECT with 99mTc MIBI were compared. Continuous intravenous (IV) infusion of perfluorocarbon exposed sonicated dextrose albumin (PESDA) (2-5 cc/min) was administered for baseline myocardial perfusion using triggered harmonic end systolic frames. Real-time digitized images were used for wall motion analysis. Dipyridamole was then injected in two steps: (1) 0.56 mg/kg for 3 min, (2) 0.28 mg/kg for 1 min, if the first step was negative for an inducible wall motion abnormality. After dipyridamole injection, myocardial contrast enhancement and wall motion were analyzed again by the same methodology.


RESULTS
There were 35 patients with perfusion defects by SPECT. Wall motion was abnormal in 22, while MCE was abnormal in 32. Wall motion and MCE each had one false positive. The proportion of correctly assigned patients was significantly better with MCE than with wall motion (p = 0.03; chi square test).


CONCLUSIONS
Myocardial contrast echocardiography, using intermittent harmonic imaging and intravenous perfluorocarbon containing microbubbles, is a very effective method for detecting coronary artery disease during dipyridamole stress echo.
Ronderos
Ricardo E
RE
Instituto de Cardiologia La Plata, Buenos Aires, Argentina. iclp@netverk.com.ar
Boskis
Mario
M
Chung
Namsik
N
Corneli
Diomedes B
DB
Escudero
Eduardo M
EM
Ha
Jong W
JW
Charlante
Carlos
C
Rim
Se-Joon
SJ
Portis
Marcelo
M
Fabris
N
N
Camilletti
Jorge
J
Mele
Anibal A
AA
Otero
Fernando
F
Porter
Thomas R
TR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000648:ultrastructure; D004176:Dipyridamole; D004452:Echocardiography / Q000379:methods; D005260:Female; D005466:Fluorocarbons; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
D003287:Contrast Media; D005466:Fluorocarbons; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi