title: Comparison of real-time myocardial contrast echocardiography for the assessment of myocardial viability with fluorodeoxyglucose-18 positron emission tomography and dobutamine stress echocardiography.
abstract: Little is known about the diagnostic value of real-time myocardial contrast echocardiography (MCE) for the assessment of myocardial viability. We compared the diagnostic accuracy of MCE with that of low-dose dobutamine stress echocardiography (DSE) and of combined technetium-99 sestamibi single-photon emission computed tomography and fluorodeoxyglucose-18 positron emission tomography and investigated whether quantitative assessment of myocardial blood flow could increase its diagnostic value. Cardiac imaging was performed with these 3 methods in 41 patients who had ischemic heart disease (ejection fraction < 40%) and were being considered for revascularization. Follow-up echocardiograms were obtained after 3 to 6 months in revascularized patients, and increased regional function served as a standard reference for assessment of myocardial viability. A control group of 25 patients who had no coronary artery disease underwent MCE to assess normal values of myocardial perfusion parameters. Recovery of myocardial function was predicted by MCE with a sensitivity of 86% and a specificity of 43%. Nuclear imaging was comparably sensitive (90%) and specific (44%), whereas low-dose DSE was similarly sensitive (83%) but more specific (76%). Normalization of myocardial signal intensity to that of the control group significantly increased the specificity of MCE from 43% to 64% and the accuracy from 73% to 81%. A combination of quantitative MCE and DSE provided the best diagnostic characteristics, with a sensitivity of 96%, a specificity of 63%, and an accuracy of 83%. Thus, MCE is useful for assessing myocardial viability. Normalization of contrast intensity to that of a reference control group is a valid approach for detection of myocardial viability and expands on information obtained from visual MCE and DSE.
authors.affiliation: Department of Department, University of Heidelberg, Germany. grigorios_korosoglou@med.uni-heidelberg.de
authors.forename: Grigorios
authors.initials: G
authors.lastname: Korosoglou
authors.forename: Alexander
authors.initials: A
authors.lastname: Hansen
authors.forename: Johannes
authors.initials: J
authors.lastname: Hoffend
authors.forename: Goran
authors.initials: G
authors.lastname: Gavrilovic
authors.forename: David
authors.initials: D
authors.lastname: Wolf
authors.forename: Joerg
authors.initials: J
authors.lastname: Zehelein
authors.forename: Uwe
authors.initials: U
authors.lastname: Haberkorn
authors.forename: Helmut
authors.initials: H
authors.lastname: Kuecherer
mesh_terms: D000328:Adult; D000368:Aged; D002470:Cell Survival / Q000502:physiology*; D004452:Echocardiography / Q000379:methods*; D025401:Echocardiography, Stress / Q000379:methods; D005260:Female; D019788:Fluorodeoxyglucose F18; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology*; D009206:Myocardium / Q000166:cytology; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D014055:Tomography, Emission-Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D017256:Technetium Tc 99m Sestamibi