Incremental benefit of myocardial contrast to combined dipyridamole-exercise stress echocardiography for the assessment of coronary artery disease.
BACKGROUND
Although assessment of myocardial perfusion by myocardial contrast echocardiography (MCE) is feasible, its incremental benefit to stress echocardiography is not well defined. We examined whether the addition of MCE to combined dipyridamole-exercise echocardiography (DExE) provides incremental benefit for evaluation of coronary artery disease (CAD).


RESULTS
MCE was combined with DExE in 85 patients, 70 of whom were undergoing quantitative coronary angiography and 15 patients with a low probability of CAD. MCE was acquired by low-mechanical-index imaging in 3 apical views after acquisition of standard resting and poststress images. Wall motion, left ventricular opacification, and MCE components of the study were interpreted sequentially, blinded to other data. Significant (>50%) stenoses were present in 43 patients and involved 69 coronary territories. The addition of qualitative MCE improved sensitivity for the detection of CAD (91% versus 74%, P=0.02) and accurate recognition of disease extent (87% versus 65% of territories, P=0.003), with a nonsignificant reduction in specificity.


CONCLUSIONS
The addition of low-mechanical-index MCE to standard imaging during DExE improves detection of CAD and enables a more accurate determination of disease extent.
School of Medicine, University of Queensland, Brisbane, Australia.
Stuart
S
Moir
Brian A
BA
Haluska
Carly
C
Jenkins
Robert
R
Fathi
Thomas H
TH
Marwick
D000368:Aged; D015897:Comorbidity; D003287:Contrast Media; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004176:Dipyridamole; D025401:Echocardiography, Stress / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005466:Fluorocarbons; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016037:Single-Blind Method
D003287:Contrast Media; D005466:Fluorocarbons; D008081:Liposomes; D004176:Dipyridamole; C042852:perflutren