title: Myocardial perfusion assessment in patients with medium probability of coronary artery disease and no prior myocardial infarction: comparison of myocardial contrast echocardiography with 99mTc single-photon emission computed tomography.
abstract: BACKGROUND
  No previous studies have compared myocardial contrast echocardiography (MCE) and single-photon emission computerized tomography (SPECT) for the detection of coronary artery disease (CAD) in patients with a medium likelihood of CAD. This study was developed to test the hypothesis that MCE is superior to SPECT for the detection of CAD.
  
  
  METHODS
  Fifty-five patients with a medium probability of CAD and no previous myocardial infarction were recruited. Results of MCE and SPECT were compared to quantitative coronary arteriography, where CAD was defined as >50% stenosis. Each patient was examined for the anterior and posterior circulations.
  
  
  RESULTS
  On a coronary circulation basis (n = 110), the sensitivity of MCE was significantly greater than that of SPECT for the detection of CAD (86% vs 43%, P <.0001). However, the specificities were similar (88% and 93%, P =.52). Both techniques were marginally more accurate in the anterior compared to the posterior circulation (88% vs 76%, P =.07 for MCE and 79% vs 63%, P =.19, for SPECT). On a patient basis (n = 55), MCE had a higher sensitivity than SPECT for the detection of CAD (83% vs 49%, P <.05). Although specificity tended to be higher for SPECT than MCE (92% vs 58%), it was not significant (P =.33). When CAD was defined as >40% coronary stenosis, the specificity of MCE increased to 83% without any change in sensitivity.
  
  
  CONCLUSIONS
  In this preliminary study, MCE was found to be superior to SPECT during dipyridamole stress for the diagnosis of CAD in patients with a medium pretest probability of CAD. Larger studies are required to confirm these findings.
authors.affiliation: Department of Cardiovascular Medicine, Northwick Park Hospital, Harrow, Middlesex, United Kingdom. roxy.senior@virgin.net
authors.forename: Roxy
authors.initials: R
authors.lastname: Senior
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Lepper
authors.forename: Agnes
authors.initials: A
authors.lastname: Pasquet
authors.forename: George
authors.initials: G
authors.lastname: Chung
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffman
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vanoverschelde
authors.forename: Manuel
authors.initials: M
authors.lastname: Cerqueira
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Kaul
mesh_terms: D000368:Aged; D003287:Contrast Media; D003327:Coronary Disease / Q000175:diagnosis*; D004176:Dipyridamole; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013667:Technetium; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D003287:Contrast Media; D004176:Dipyridamole; D013667:Technetium