Assessment of myocardial perfusion with intravenous contrast echocardiography: comparison with (99) Tc-tetrofosmin single photon emission computed tomography and dobutamine echocardiography.
The aim of the study was to evaluate the accuracy of intermittent, harmonic power Doppler (HPD) during intravenous Levovist infusion in identifying myocardial perfusion abnormalities in patients with recent infarction. Fifty-five patients with first acute myocardial infarction, successfully treated by primary PTCA, were studied after 1 month by myocardial contrast echocardiography (MCE), 99mTc tetrofosmin single photon emission computed tomography (SPECT), and low dose dobutamine echocardiography (DE). Scoring myocardial perfusion as normal, moderately, or severely reduced; MCE and SPECT were in agreement in 71% of segments(k = 0.414). Discordance was mainly due to ventricular walls with normal enhancement by MCE and moderate perfusion abnormalities by SPECT. Scoring perfusion as present or absent, the agreement significantly improved up to 86% (k = 0.59). Sensitivity and specificity of HPD for identifying SPECT perfusion defects were 63% and 93%, respectively. The agreement between MCE and SPECT was higher(85%, k = 0.627)in patients with anterior infarction. An improvement in regional contractile function was noted after dobutamine in 79 dysfunctional segments. A normal perfusion or a moderate perfusion defect by MCE were detected in 71 of 79 of these segments, while a severe perfusion defect was observed in 59 of 85 ventricular segments without dobutamine-induced wall-motion improvement. Sensitivity and specificity by HPD in detecting segments with contractile reserve were 90% and 69%, respectively. Thus, intermittent HPD during Levovist infusion allows myocardial perfusion abnormalities to be detected in patients with recent infarction. This method has a limited sensitivity but a high specificity in detecting SPECT perfusion defects, and a good sensitivity but a limited specificity in detecting contractile reserve.
Palagi
Caterina
C
Cardiothoracic Department, Pisa University, Pisa, Italy.
Mengozzi
Giovanna
G
Rovai
Daniele
D
Volterrani
Duccio
D
Dell'Anna
Rita
R
Giorgi
Davide
D
Petronio
Anna Sonia
AS
Di Bello
Vitantonio
V
Mariani
Mario
M
D003287:Contrast Media; D003326:Coronary Circulation; D004280:Dobutamine; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011134:Polysaccharides; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon
D003287:Contrast Media; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011134:Polysaccharides; D019275:Radiopharmaceuticals; C059891:SHU 508; D004280:Dobutamine; C078700:technetium tc-99m tetrofosmin