title: Comparison of usefulness of dipyridamole stress myocardial contrast echocardiography to technetium-99m sestamibi single-photon emission computed tomography for detection of coronary artery disease (PB127 Multicenter Phase 2 Trial results).
abstract: We hypothesized that assessment of hyperemic myocardial blood flow (MBF) velocity using myocardial contrast echocardiography (MCE) can detect coronary artery disease (CAD). We also postulated that only a single MCE study during stress is required for the detection of CAD in patients with normal function at rest. Patients with known or suspected CAD referred for dipyridamole stress technetium-99m sestamibi single-photon emission computed tomographic (SPECT) studies were enrolled. MCE was performed concurrently with SPECT using continuous infusions of PB127 during intermittent harmonic power Doppler imaging at multiple pulsing intervals. MCE and SPECT were compared in 43 of 54 patients who had adequate studies using both techniques. In 15 of the 43 patients, coronary angiography was performed within 30 days of the MCE/SPECT tests. Overall concordance for classification of patients as normal versus abnormal was 84% (kappa = 0.63) between the 2 tests. When false-negative SPECT scans were corrected for results of angiography, concordance increased to 93% (kappa = 0.82). For territorial analysis, concordance between MCE and SPECT for location of perfusion defects was 65% (kappa = 0.41) and 74% (kappa = 0.61) after SPECT was corrected by angiography. In patients with normal function at rest, a single stress MCE perfusion study allowed identification of CAD with the same concordance as rest/stress perfusion studies. In conclusion, visual assessment of regional differences in MBF velocity using PB127 allows detection of CAD with good concordance compared with technetium-99m sestamibi SPECT. In patients with normal left ventricular function at rest, a single stress PB127 MCE perfusion study is adequate for the detection of CAD.
authors.affiliation: 1026 Cobb Hall, Hospital Drive, University of Virginia, Charlottesville, VA 22901, USA. kwon@virginia.edu
authors.forename: Kevin
authors.initials: K
authors.lastname: Wei
authors.forename: Linda
authors.initials: L
authors.lastname: Crouse
authors.forename: James
authors.initials: J
authors.lastname: Weiss
authors.forename: Flordeliza
authors.initials: F
authors.lastname: Villanueva
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Schiller
authors.forename: Tasneem Z
authors.initials: TZ
authors.lastname: Naqvi
authors.forename: Robert
authors.initials: R
authors.lastname: Siegel
authors.forename: Mark
authors.initials: M
authors.lastname: Monaghan
authors.forename: Jonathan
authors.initials: J
authors.lastname: Goldman
authors.forename: Paul
authors.initials: P
authors.lastname: Aggarwal
authors.forename: Harvey
authors.initials: H
authors.lastname: Feigenbaum
authors.forename: Anthony
authors.initials: A
authors.lastname: DeMaria
mesh_terms: D000328:Adult; D000465:Algorithms; D001783:Blood Flow Velocity / Q000187:drug effects; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003326:Coronary Circulation / Q000187:drug effects; D004176:Dipyridamole; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D019275:Radiopharmaceuticals; D012016:Reference Values; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014665:Vasodilator Agents; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi