title: Real-time dobutamine stress myocardial contrast echocardiography for detecting coronary artery disease: correlating abnormal wall motion and disturbed perfusion.
abstract: BACKGROUND
  Real-time myocardial contrast echocardiography (MCE) makes possible the simultaneous visualization of changes in perfusion imaging and wall motion.
  
  
  OBJECTIVE
  To assess the accuracy of real-time MCE for detecting the presence and extent of coronary artery disease (CAD), and to evaluate the correlation between wall motion and myocardial perfusion by visual examination.
  
  
  METHODS
  A total of 140 consecutive patients without resting wall motion abnormalities were screened to undergo dobutamine stress MCE with power modulation and coronary angiography. Significant coronary disease was defined by the quantification of over 50% stenosis in a major epicardial vessel. The visual identification of wall motion and myocardial perfusion abnormalities was determined by blind review.
  
  
  RESULTS
  Eight patients were excluded due to suboptimal images (feasibility 94.3%). Myocardial contrast enhancement analysis and wall motion analysis were similar in terms of sensitivity (81.2% versus 83.5%, respectively) and specificity (76.5% versus 80.9%, respectively) in detecting the presence of CAD. Myocardial contrast enhancement analysis tended to have a greater sensitivity than wall motion analysis in detecting the ischemic extent over multiple vascular territories among patients with multiple-vessel disease (sensitivity 83.8% versus 71.4% [P=0.09], and abnormal segment length 54.7+/-21.1% versus 48.9+/-24.7% [P=0.03] for myocardial contrast enhancement and wall motion analysis, respectively). There was good concordance between the presence of myocardial ischemia and wall motion abnormality for the segment-by-segment analysis (89.7% agreement, kappa = 0.745). The correlation of the wall motion score and perfusion score at peak stress was also good (r=0.793, P=0.015).
  
  
  CONCLUSIONS
  Dobutamine stress MCE with power modulation is similar in sensitivity and specificity to wall motion analysis for detecting the presence of CAD. However, it provides greater sensitivity in evaluating the extent of ischemia in patients with multiple-vessel disease.
authors.affiliation: Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.
authors.forename: Kuan-Rau
authors.initials: KR
authors.lastname: Chiou
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Huang
authors.forename: Shoa-Lin
authors.initials: SL
authors.lastname: Lin
authors.forename: Pu-Lin
authors.initials: PL
authors.lastname: Hsieh
authors.forename: Chun-Peng
authors.initials: CP
authors.lastname: Liu
authors.forename: Daw-Guey
authors.initials: DG
authors.lastname: Tsay
authors.forename: Hung-Ting
authors.initials: HT
authors.lastname: Chiang
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003326:Coronary Circulation / Q000502:physiology; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D013624:Taiwan / Q000453:epidemiology